Clonsilla Auto Sales

Credit Application

You may apply for credit pre-qualification by supplying the information below. By submitting this form, you give us permission to request credit information from the major credit bureaus on your behalf. Fields marked with an asterisk (*) are required.
*First Name:
*Last Name:
*Home Phone:
*Work Phone:
*Email:
Do you have an active bankruptcy?	Yes No
Is a consigner available if needed ?	Yes No
Date of birth:
Social security number:
Current Address
*How Long?
*Address:
Address Cont:
*City:
*Province:
*Postal Code:
*Rent or Own:	Rent Own
*Live with relatives?	Yes No
*Rent or Mortgage amount:
Previous Address - If less than 2 Years
How Long?
Address:
Address Cont:
City:
Province:
Postal Code:
Rent or Own:	Rent Own
Live with relatives?	Yes No
Rent or Mortgage amount:
Current Employer
*Employer name:
*Occupation title:
*Address:
Address Cont:
*City:
*Province:
*Zip:
*Gross monthly income:
*Other income:
*How long have you worked there?
Previous Employer - If less than 2 Years
Employer name:
Occupation title:
Address:
Address Cont:
City:
Province:
Zip:
Gross monthly income:
Other income:
How long have you worked here?
3 References and phone numbers
*1:	Phone:
*2:	Phone:
*3:	Phone:
Please enter any comments or other information:

By supplying this information, you give us permission to request credit information from the major credit bureaus, to pre-qualify you for your purchase.
Do you give Clonsilla Auto Sales permission to check your credit report?