PERSONAL INFORMATION
First Legal Name
Middle Name
Last Name
Mr
Mrs
Other
>> Select
Date of Birth
Social Insurance Number
Spouse/Joint Applicant
First Legal Name
Middle Name
Last Name
Mr
Mrs
Other
>> Select
Date of Birth
S.I.N
Present Address
Apt. No.
City/Town
Province
Postal Code
>> Select
BC
AB
SK
MB
ON
QC
NS
NB
PE
NL
NT
YT
NU
Marital Status
Living Status
How long at present?
>> Select
Married
Single
Divorced
Separated
>> Select
Rent
Own
Live with parents
Room and Board
Home Phone Number
Email address
Landlord's Name
Landlord's Phone
Previous Address
How long?
EMPLOYMENT INFORMATION
Current
Employer Name
Phone Number
Occupation/Position
How long?
Gross Monthly Income
Previous
Employer Name
Phone Number
Occupation/Position
How long?
Gross Monthly Income
Spouse/Joint Applicant Employer Name
Current
Employer Name
Phone Number
Occupation/Position
How long?
Gross Monthly Income
Previous
Employer Name
Phone Number
Occupation/Position
How long?
Gross Monthly Income
Other sources
Other income sources
Phone Number
Occupation/Position
How long?
Total Monthly Income
BANKING INFORMATION
Bank 1
Name of bank
Type of Account
Account #
Average Balance
Bank 2
Name of bank
Type of Account
Account #
Average Balance
Real estate
Registered owner(s)
Approximate value
Other assests (including real estate/vehicles)
Approximate value
CREDIT INFORMATION
Housing Pmnt
Name of Creditor
Account/Loan Number
Original Balance
Includes principal, interest & taxes
Owing since
Amount currently owing
Total Monthly Payment
Line of Credit
Name of Creditor
Account/Loan Number
Original Balance
Owing since
Amount currently owing
Total Monthly Payment
Car Loan/Lease
Name of Creditor
Account/Loan Number
Original Balance
Owing since
Amount currently owing
Total Monthly Payment
Bank CC
Name of Creditor
Account/Loan Number
Original Balance
Owing since
Amount currently owing
Total Monthly Payment
Credit Card
Name of Creditor
Account/Loan Number
Original Balance
Owing since
Amount currently owing
Total Monthly Payment
Other
Name of Creditor
Account/Loan Number
Original Balance
Includes alimony, child support, etc.
Owing since
Amount currently owing
Total Monthly Payment
Total amount owing Total Monthly Payments
Have you declared bankruptcy in the past 7 years?
>> Select
Yes
No
Have you had a vehicle repossessed?
>> Select
Yes
No
Drivers Licence #
Personal Reference (not in same household)
Name
Address
Relationship
Phone Number
CREDIT AGREEMENT
I certify that the information is correct
Keystone Auto Leasing Inc. may from time to time give any credit and other information about me, including any information on this form, to or receive such information from: (A) Any credit bureau or reporting agency; (B) any person with whom I have or propose to have financial dealings; and (C) any person in connection with any dealings I have with or propose to have with Keystone Auto Leasing Inc.
I agree that Keystone Auto Leasing Inc. may use the above listed information to establish and maintain my relationship with Keystone Auto Leasing Inc. and to offer any services as permitted by law.
Date Applicant Signature Joint Applicant Signature
