Ducharme Motors Ltd.
Online Credit Application Form
 * Required Fields
Personal Information
First Name *   Last Name *  
Date of Birth *   Marital Status *  
Cell Phone Number   SIN Number  
E-Mail Address   Driver's License #  
Current Residence
House No./Box No. *   Street Name *  
Street Type *   City *  
Province *   Postal Code *  
Years at Address *   Months at Address *  
Home Phone # *        
Previous Residence (If less than 2 years at Current) Optional
House No./Box No.   Street Name  
Street Type   City  
Province   Postal Code  
Years at Address   Months at Address  
Home Phone #          
Current Employment
Employment Type *   Job Title *  
Employer Name *   Employer Address  
Employer City   Employer Province  
Years with Employer *   Months with Employer *  
Previous Employment (If less than 2 years at Current) Optional
Employment Type   Job Title  
Employer Name   Employer Address  
Employer City   Employer Province  
Years with Employer   Months with Employer  
Finances
Gross Monthly Salary *   Monthly Commissions *  
Monthly Car Allowance *   Other Monthly Income *  
Other Income Description   Total Monthly Income *  
Current Home Status *   Mortgage Holder's Name  
Monthly Rent/Mortgage Payment *   Home's Market Value  
Mortgage Balance   Other Monthly Obligations  
        Other Obligations Description  
Banking
Bank Name *   Years at Bank *  
Trade-In Optional
Year   Make  
Model   VIN  
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/Auto Dealer to conduct a personal investigation, and by submitting this, you accept as notice in writing of and authorize the obtaining of any information required that may be relating to this application, from any source to whom the Bank/Auto Dealer may apply and each source is authorized to provide the Bank/Auto Dealer with information. In addition, you authorize the Bank/Auto 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/Auto Dealer considers appropriate and agreement is made to release the Bank/Auto Dealer and save it harmless from any claims, damages or otherwise arising from such disclosure made by the Bank/Auto Dealer.  
       
I accept the Terms and Conditions
*
 
  
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