Read this first: All information is held by Cars Of All Kinds Inc. in the strictest of confidence. There are no mandatory fields on the form so if you choose not to fill in any field for whatever reason (ie privacy concerns, etc...) then the form will still be transmitted. The application will be processed based on the information provided unless there is insufficient information to do so, in which case you will be contacted by Cars Of All Kinds Inc. and given an opportunity to provide such information.There is no contractual obligation upon you by merely filling in this form.

If you wish you can print the form and fax it to us at (613) 737-6671.

1. PERSONAL INFORMATION:

Surname:	First Name:
Middle Name:	Address:
City:	Province :
Country:	Postal Code:
Area Code: No.	E-Mail Address :
DOB:	Place of Birth:
Social Insurance Number:

2. PROPERTY:

RENT OWN

If you rent list the period of time that you have resided at the above address, your monthly rent and the name, address and telephone number of the landlord.

If you own scroll down the page past Rental History

3. RENTAL HISTORY:

Minimum 3 year residence requested:

Period of Time: (FROM: Month & Year / TO: Month and Year). Start with current address and particulars. Use comment field at bottom if more space is need.

Also include: Landlord's name and telephone number. .

3 a) Rental Address History:

Period of Time:	Rent Payment:
Address:	Landlord:
Telephone:

3 b) Rental Address History: (Additional boxes if needed)

Period of Time:	Rent Payment:
Address:	Landlord:
Telephone:

3 c) Rental Address History: (Additional boxes if needed)

Period of Time:	Rent Payment:
Address:	Landlord:
Telephone:

4. OWNER OF RESIDENCE:

If you own your own residence list the monthly mortgage payment and the name of the Mortgage Holder.

Monthly Payment :

Mortgage Holder:

5. EMPLOYMENT HISTORY:

(Mininum 2 year History is needed)

Commence with current employer (if more space is needed fill in the comment box at bottom of form)

5 a.) Employment History:

Employer:	Position:
Address:	City:
Business Number:
Gross Monthly Income:	Net Monthly Income:
How Long (Year/Month) :	Business Telephone:

5 b.) Employment History: (If additional space is required, please place it in the comment field below.

Employer:	Position:
Address:	City:
Business Number:
Gross Monthly Income:	Net Monthly Income:
How Long (Year/Month) :	Business Telephone:

6. FINANCIAL INSTITUTIONS: ( i.e. Banks, Credit Unions, Cooperatives)

Bank:	Branch:
Bank:	Branch:
Credit Reference:	Credit Reference:

7. BANKRUPTCY:

Have you ever been bankrupt ?

YES NO

If yes, please provide the following information:

Amount of bankruptcy:	Discharge date:
Trustees Name:	Telephone No:
Credit Reference:	Credit Reference:

8. COMMENTS: (For comments or additional information)

HOW TO CONTACT:

1401 Cyrville Road Map & directions

Gloucester, Ontario,

Canada.

K1B 3L7

E-Mail

(613) 737-6671

Updated: 2004

Created by: CyberAds Agency

Copyright April 16, 1998