First Name *	Middle Name	Last Name *
Social Insurance Number *
Month of Birth * JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember	Date of Birth * 01020304050607080910111213141516171819202122232425262728293031	Birth Year *
Address *
City *	Province * AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon	Postal Code *
Home Phone Number *	Cell Phone
Own or Rent *	Monthly Payment *	Time at Residence (Years) *
Name of Mortgage Holder
Current Employer *		Employer Phone *
Length of Employment *	Occupation	Income *
Previous Employer		Length of Employment
Other Vehicles	Payment/Amount Owing *
Security Code *

A consumer/personnel report containing credit, medical or personal information will be referred to in a connection with this application and the undersigned hereby consents to the preparation of such a report and the undersigned hereby consents to Wapiti Auto Sales obtaining credit, medical or personal information reports representing the undersigned from consumer reporting agencies. The undersigned hereby consents and acknowledges that Wapiti Auto Sales had its successor assigns shall have the right to disclose any information contained in a consumer/personal report of the undersigned to other credit grantors or consumer reporting agencies in its own discretion or upon referral of the undersigned. Note this content allows information on a spouse to be included in any report.