Credit Application

Vehicle Information:
Year:
Make:
Model:
Price:

Personal Information:
Salutation*:	Mr Ms Miss Mrs
Home Phone*:	()-
Email Address*:
First Name*:
Middle:
Last Name*:
Age*:
Birth Date(MM/DD/YYYY)*:
Marital Status*:	Single Married Partner Divorced Separated

Spouse's Information:
First Name:
Last Name:
Birth Date*:
Spouse's Employer:
Address:
City:
Province:	AB BC MB NB NL NS NT ON PE QC SK YT
Employer's Phone:	()-
How Long Employed: (Years/Months)

Residence Information:
PRESENT ADDRESS
Address*:
City*:
Province*:	AB BC MB NB NL NS NT ON PE QC SK YT
Postal Code*:
How Long (Years/Months)*:
PREVIOUS RESIDENCES
Address:
City:
Province:	AB BC MB NB NL NS NT ON PE QC SK YT
How Long: (Years/Months)
Address:
City:
Province:	AB BC MB NB NL NS NT ON PE QC SK YT
How Long: (Years/Months)

Employment Information
PRESENT EMPLOYER
Name:*
Address:*
City:*
Province:	AB BC MB NB NL NS NT ON PE QC SK YT
How Long Employed: (Years/Months)
Occupation:*
Work Phone*:	()-
Rank (If military)
Dept. or Supv.:*
PREVIOUS EMPLOYER(if less then 2 years at present employer)
Name:
Address:
City:
Province:	AB BC MB NB NL NS NT ON PE QC SK YT
Name:
Address:
City:
Province:	AB BC MB NB NL NS NT ON PE QC SK YT

Reference Information
Applications Nearest Relative(Not In Household):
Relationship:
Address:
City:
Province:	AB BC MB NB NL NS NT ON PE QC SK YT
Phone:	()-
Personal Reference:
Address:
Phone:	()-

By submitting this form, you give Kramer Mazda the right to store and forward your personal information for the sole purpose of fulfilling your request. This information will not be provided to any other party other than the one handling your request, without your prior consent.