Secure Finance Application

Statement of Consent

The undersigned is applying for credit and verifies that all credit and other information provided to Lifestyles Financial Services Ltd. will be true and accurate. LFS and any other bank or finance company involved in this transaction is authorized to conduct a credit investigation on the undersigned and to exchange credit and other information with any credit bureau or reporting agency.

Initial Here

Co-Applicant's Initial Here

Vehicle Information

Type

Condition

Year

Make

Model

Down Payment

Your Contact Information

Name As It Appears on Driver's License

First Name

Middle Name

Last Name

Driver's License

Driver's License Province

Driver's License Expire Date

Work Phone

Cell Phone

E-mail

Social Insurance

Male / Female

Date of Birth

Marital Status

Spouse Name

Spouse Income

Physical Address Information

Physical Address

City

Province

Postal Code

Housing Information

Do you Rent or Own your home, or other?

LandLord / Mortgage Holder

Rent / Mortgage Monthly Amount

Mortgage Balance

Time at Current Residence

Previous Residence (If less than 2 years at Current Residence...)

Address

City

Province

Postal Code

How long at Previous Residence

Banking Information

Name Of Bank

Account Types

Name Of Bank

Account Types

Credit Card

Expiration Date

Type

Employer Information

Occupation

Employer Name

Employer Address

Employer City

Employer Province

Employer Postal Code

Employer Phone

Gross Monthly Income

Time at Employer

Type of Employment

Other Income

Other Income Frequency

*** If employment is less than 2 years, please provide previous employment information ***

Occupation

Employer Name

Employer Address

Employer City

Employer Province

Employer Postal Code

Employer Phone

Gross Monthly Income

Time at Employer

Additional Comments

Please include any information that you feel may help us process your application.

Joint Applicant Contact Information

First Name

Middle Name

Last Name

Driver's License

Driver's License Province

Driver's License Expire Date

Work Phone

Cell Phone

E-mail

Social Insurance

Date of Birth

Joint Physical Address Information

Physical Address

City

Province

Postal Code

Joint Applicant Housing Information

Do you Rent or Own your home, or other?

LandLord / Mortgage Holder

Rent / Mortgage Monthly Amount

Time at Current Residence

Joint Applicant Previous Residence (If less than 2 years at Current Residence...)

Address

City

Province

Postal Code

How long at Previous Residence

Joint Applicant Banking Information

Name Of Bank

Account Types

Name Of Bank

Account Types

Joint Applicant Employer Information

Occupation

Employer Name

Employer Address

Employer City

Employer Province

Employer Postal Code

Employer Phone

Gross Monthly Income

Time at Employer

Other Income

Other Income Frequency

*** If employment is less than 2 years, please provide previous employment information ***

Occupation

Employer Name

Employer Address

Employer City

Employer Province

Employer Postal Code

Employer Phone

Gross Monthly Income

Time at Employer

Joint Applicant Additional Comments

Please include any information that you feel may help us process your application.

References

Name

Phone

City

Province

Name

Phone

City

Province

Name

Phone

City

Province

Name

Phone

City

Province