Wrightway Leasing Limited - Credit Application
Full Name
Social Insurance Number
Drivers License Number
Date Of Birth (Y/M/D)
Marital Status
Married
Single
Common Law
Divorced
Spouse's Full Name
Spouse's S.I.N.
Spouse's Driver's License Number
Date of Birth (Y/M/D)
Number Of Dependants
Current Address (Number and Street Name)
Apartment
How Long Have You Lived There
City
Province
Postal Code
Home Phone
Name & Address Of Landlord or Mortgage Holder
Monthly Payment
Own / Rent
1st Previous Address (If Changed In Last 5 Years)
How Long Did You Live There
2nd Previous Address
How Long Did You Live There
Employer Name & Address
Employer Phone
Position Held
Supervisor
How Long
Monthly Income
Spouse's Employer
Employer Phone
Position Held
Supervisor
How Long
Monthly Income
1st Personal Reference
Address
Relationship
Phone
2nd Personal Reference
Address
Relationship
Phone
3rd Personal Reference
Address
Relationship
Phone
Bank
Branch
Chequing Account Number
Phone
1st Credit Reference (Name & Account Number)
Montly Payment
Balance Owing
2nd Credit Reference (Name & Account Number)
Montly Payment
Balance Owing
3rd Credit Reference (Name & Account Number)
Montly Payment
Balance Owing
Have you claimed bankruptcy in the last 7 years?
Have you had a car repossessed in the last 7 years?
Insurance Company
Address
Contact
Collision Deductible
Comp. Deductible
PL/PD Amount
Monthly Income:
Monthly Expenses:
Employment Net:
Rent or Mortgage:
Spouse's Employement Net:
Car Costs (Incl. gas, maint.):
Other Income:
Other:
Total Income:
Total Expenses:
The undersigned hereby warrants the information given to be true, complete and accurate. In accordance with the Privacy Act, all information is held in strict confidence.
Email Address:
Date:
20
Customer's Signature Spouse's Signature