Cross Roads Motors Credit Application

Personal Information

Title    Mr.     Mrs.     Miss     Ms.
* First Name
* Middle Name
* Last Name
* Date of Birth (MM/DD/YYYY)
* SIN #
* Marital Status
* Home Phone (with area code)
* Cell No
* Email

Employment Information

* Employer
* Employer Phone (with area code)
* Employer Address
* Employer City
* Employer Province
* Employer Postal Code
Type of Position    Full-Time       Part-Time       Contract       Seasonal
* Time with Current Employer    e.g. (4 years, 6 months)
* Monthly Income (Before Tax)
Self Employed
Additional Income
If less than 3 years at current employer, please click here.

Residential Information

* Street Name
* Street Number
* City
* State / Province
Postal Code
Monthly Rent/Mortgage or Other Payment  
Mortgage Balance Amount
Mortgage Holder
Value of your Home
* Time at Residence    e.g. (4 years, 6 months)
* Bankcruptcy
* Discharge Date (MM/DD/YYYY)
If less than 3 years at current address, please click here.

Co-Signer or Spouse Information

If you have a co-signer or spouse, please click here.

Other Information

Your Bank's Name
What type of vehicle are you interested in?
Do you have a trade-in?    Yes       No
Trade Value
Approximate Downpayment
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Additional comments

Privacy Policy

By submitting this application form, you certify that the information you have provided herein is true and correct to the best of your knowledge. You also authorize the Bank/Dealer to conduct a personal investigation, and by submitting this, you accept as notice in writing of and authorize the obtaining of any informationthat may be relating to this application, from any source to whom the Bank/Dealer may apply and each source is authorized to provide the financial institution with information. In addition, you authorize the Bank/Dealer to disclose, in response to direct inquiries from any other lender or credit bureau, any information concerning your loan and account that the Bank/Dealer considers appropriate.
* Signature (retype your full name)
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