CREDIT APPLICATION

Privacy Statement: Legacy Auto Gallery is dedicated to protecting our customers privacy. Any information is on a voluntary basis. Information provided is for internal use only. We do not sell, rent or transmit personal information to other organizations.

CANADIAN RESIDENTS ONLY

Please fill in the following areas so we can respond as accurately as possible.
Contact Information
Which vehicle you are interested in:
Your Name: * required field
Street Address:
City:
Postal Code:
Province/Territory:
Telephone: * required field
Fax:
Email address: * required field
Do you   How long at present address?
If less then 2 years give previous address
Monthly Rent/Mortgage Payment:
Employment Information
Employment Status:
If employed, please fill out the remainder of this section.
Employer Name:
Employer Address:
How many yrs. at current employer?
If less then 2 yrs. at current employer, give previous employer
Occupation:
Work Telephone:
Gross Monthly Income:
Financial Information
Have you ever declared bankrupcy?:
 Yes   No
If yes, date of discharge:

Financial Institution Name:
Financial Institution Address:
Our Finance Agent may contact you by phone for additional information.