Canton Motors Inc.

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Financing
For information on your personal financing options, please fill out the information requested below, and then click on the "Submit" button.*

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Application Information
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Type of application:

If you are applying with a joint application, please have the cosigner complete the form after the primary applicant has hit Submit.

Identification
First Name: Middle Initial
Last Name:
Date of Birth: Month
Date of Birth: Day
Date of Birth: Year
Social Security Number:
Drivers License No:
State: Expiration date:

Contact Information
EMail:
(Area Code) Daytime Phone:
(Area Code) Evening Phone:
(Area Code) Cell Phone:

Address Information
Address: City:
State: Zip:
Do you rent or own? Mthly rent/mtg:
How long at your current residence? Years Months

If less than 2 years - please complete previous history information below.
Previous Address: Previous City
Previous State: Zip:
How long at previous residence? Years Months:

Employment History

Current Employer: Phone:
Occupation: Gross Monthly Income (before taxes):
Address City:
State: Zip:
Job Length? Years Months

If less than 2 years - please complete previous history information below.

Previous Employer: Phone
Address City
State Zip:
Previous Job Length? Years Months:

Questionnaire

Other Monthly Income - $: Source of other income (disability, alimony, child support):
Bank Name Account Type:
Education:
Have you ever filed for bankruptcy? If yes, when:
Have you ever had a car or other merchandise repossessed? If yes, when:

Personal References

Personal Reference Relationship
Address City and State
Zip: Phone

Personal Reference Relationship:
Address City and State:
Zip: Phone:

I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience. I have read and received a copy of your Privacy Notice and agree to all of the above.
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