Applicant Questions:

Do you make $1,800 or more per month? yes no Have you lived at your current address for 6 months or more? yes no Have you worked at your current job for 6 months or more? yes no Can you afford a minimum payment of $200/mth or more? yes no Do you have a true desire to rebuild your credit? yes no Do you want a quality, low km vehicle with warranty? yes no Do you have a small down payment or vehicle to trade in? yes no

Applicant Information:

First Name: Last Name: Birth Date: SIN: Street Address: City: Province: Alberta British Columbia Manitoba New Brunswick Newfoundland / Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon Postal Code: Home Phone: Email: Time at current address: Payment Cont. / Mortgage:

Employment Information:

Employer Name: Duration: Occupation: Employment Type: City: Province: Alberta British Columbia Manitoba New Brunswick Newfoundland / Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon Work Phone: Monthly Gross: Comments:

Affordable Car Company
1753 Hanwell Road, Fredericton NB, E3C 1N3
Tel: 506-453-9095