Credit Application

Thank you for your interest in financing a vehicle from Regina Used Vehicles Dot Com. Please fill out the following application and it will be reviewed by our Business Manager as soon as possible.

Please note: Although providing your social insurance number is not required, you are encouraged to provide it as it allows us to process your application quicker, with accurate information.

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Values marked with a * are required entries. Please do not use spaces or dashes in the telephone number or social insurance number fields.

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Personal Information   First Name: * Middle Initial: Last Name:* Social Insurance Number: Birth Date: * -Month- January February March April May June July August September October November December - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Address:* City:* Province:* Saskatchewan Alberta British Columbia Manitoba New Brunswick Newfoundland North West Territories Nova Scotia Nunavut Ontario Quebec Yukon Postal Code:* Home Telephone Number:* ()     Email Address:* Marital Status: Choose... Single Married Divorced Seperated Common Law How long have you lived at the above address?* Years:   Months:     Choose... Own Rent Live With Family Other   Landlord:*   Monthly Payment:* $   Mortgage Lender:*   Monthly Payment:* $   Balance:* $   Market Value:* $ Since you have not been at your current residence for more than 2 years please fill out the following information about your previous residence. Address:* City:* Province:* -Select Province- Saskatchewan Alberta British Columbia Manitoba New Brunswick Newfoundland North West Territories Nova Scotia Nunavut Ontario Quebec Yukon Postal Code:* Employment and Income Information   Occupation:* Employer:* How long have you worked there?*  Years:  Months: Work Telephone Number:* ()     Since you have not been at your current job for more than 2 years please fill out the following information about your previous job. Occupation:* Employer:* How long did you work there?*  Years:  Months: Work Telephone Number:* ()       Gross Monthly Income: * $ Additional Monthly Income: $ Source of Additional Income: Co-Applicant Information   Is there a Co-Applicant?   No Yes Personal Information   First Name: * Middle Initial: Last Name:* Social Insurance Number: Birth Date: * -Month- January February March April May June July August September October November December - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Does the co-applicant has the same address information as the primary applicant? No Yes Address:* City:* Province:* * -Select Province- Saskatchewan Alberta British Columbia Manitoba New Brunswick Newfoundland North West Territories Nova Scotia Nunavut Ontario Quebec Yukon Postal Code:* Home Telephone Number:* ()     Email Address: Marital Status: Choose... Single Married Divorced Seperated Common Law How long have you lived at the above address?* Years:   Months:     Choose... Own Rent Live With Family Other   Landlord:*   Monthly Payment:* $   Mortgage Lender:*   Monthly Payment:* $   Balance:* $   Market Value:* $ Since you have not been at your current residence for more than 2 years please fill out the following information about your previous residence. Address:* City:* Province:* -Select Province- Saskatchewan Alberta British Columbia Manitoba New Brunswick Newfoundland North West Territories Nova Scotia Nunavut Ontario Quebec Yukon Postal Code:* Employment and Income Information   Occupation:* Employer:* How long have you worked there?*  Years:  Months: Work Telephone Number:* ()     Since you have not been at your current job for more than 2 years please fill out the following information about your previous job. Occupation:* Employer:* How long did you work there?*  Years:  Months: Work Telephone Number:* ()       Gross Monthly Income:* $ Additional Monthly Income: $ Source of Additional Income: Vehicle Information   Vehicle Interested In: Salesperson (if any): Make: Model: Stock Number (if known): Trade-in Information   Do you have a vehicle to trade in?   No Yes Make:* Model:*                               Year:*            Outstanding Balance:* Lender:* Additional Notes: Additional Information   Please feel free to provide any additional information that may pertain to this application in the box below: I agree that Regina Used Vehicles Dot Com may use the provided information for credit purposes.