Badanai Motors Ltd.

Submission Form
Use the form below to submit your information to Badanai Motors.

Personal Information
First Name:
Initial:
Last Name:
Social Insurance Number:
Birth Date:
Home Phone:
Cellular Phone:
Residence Information
Address:
City:
Province:
Postal Code:
Duration at Residence:		Years: Months:
Type:
Rent/Mortgage Payment:		$
Landlord/Mortgage Holder:
Mortgage Currently Owing:		$
Market Value of Home:		$
Empoyment Information
Name:
Address:
City:
Province:
Employment Duration:		Years: Months:
Occupation/Job Title:
Work Phone:
Gross Income Per Month:		$
Spouse's Information
First Name:
Last Name:
Social Insurance Number:
Birth Date:
Spouse's Employer:
Employer's Address:
Employer's City:
Employer's Province:
Employer's Phone:
Length of Employment:		Years: Months:
Gross Income Per Month:		$

Comments Acknowledgment and Consent I/We certify that the above information is complete and accurate to the best of my/our knowledge. I/we further certify that I/we have attained the age of majority. Creditors receiving this application will retain the application whether or not is approved. Creditors may rely on this application in deciding whether to grant the requested credit. False statements may subject me to criminal penalties. I/we authorize the creditors to obtain credit reports about me/us on an ongoing basis during this credit transaction and to check my/our credit and employment history on an on going basis during the term of the credit transaction. If this application is approved, I/we authorize the creditor to give credit information about me/us to its affiliates.


© 2003 Badanai Motors Ltd.