( fields marked with a "*" are required )
GENERAL INFORMATION
Name:*
Phone:*	Day
	Night
Best Time To Call:
E-Mail:*
Time Frame:	Immediately Within next week In one to two weeks Within next month More than a month from now
Buy:	Purchase Lease
VEHICLE INFORMATION
Year:
Make:
Model:*
Stock Number:
Color:
Features & Options:
Down Payment:	$ or less
Payment:	$ per month
TRADE INFORMATION
Trade In:	Yes, I want to trade in a vehicle No, I do not want to trade in a vehicle
Trade In Details:	If Yes, please describe the trade in vehicle
PERSONAL INFORMATION
Full Name:*
Date of Birth:*
Social Insurance Number:*
Address:*
City:
Province:
Postal Code:*
How long at this address:*	Own Rent
CO-BUYERS PERSONAL INFORMATION
Full Name:
Date of Birth:
Social Security Number:
Address:
City:
Province:
Postal Code:
How long at this address:	Own Rent
EMPLOYMENT INFORMATION
Employer:*
Employer Address:*
City:
Province:
Postal Code:*
How long have you worked here:*
Occupation:*
Salary:*	$ Weekly Monthly Yearly
By completing and submitting this form you hereby authorized representatives of Erin Mills Mazda to research and review your credit history and/or submit your application to funding sources for research, review and approval.