Apply Now Customer Application Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastPhone Number *Alternative Phone NumberCanadian Status *Canadian CitizenPermanent ResidentTemporary Resident/Student PermitTemporary Resident/Work PermitRefugee ClaimantSIN #Gender *FemaleMaleMarital Status *SingleMarriedCommon lawWidowedDivorcedDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920EmailAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeTime living at this address (months/years) *Home Status *OwnRentLiving with parentsMonthly Payment/RentHome Market ValueMortgage AmountPrevious AddressTime living at previous addressEmployment InformationCompany Name *Company AddressCompany Phone Number *Position HeldType of EmploymentFull timePart timeSelf-employedRetiredLength of Employment (months/years) Gross Monthly Income (before taxes)Is length of current employment greater that 2 years? *YesNoIf your started your current job less that 2 years ago, please fill up the information for your previous employment.Company Name *Company AddressCompany Phone Number *Position HeldType of EmploymentFull timePart timeSelf-employedRetiredLength of Employment (months/years)Gross Monthly Income (before taxes)Other Income Source and amount Co-signer available? *YesNoCo-signer InformationName *FirstLastDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Canadian Status *Canadian CitizenPermanent ResidentTemporary Resident/Student PermitTemporary Resident/Work PermitRefugee ClaimantSIN #Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodePhone NumberCo-signer Employment InformationCompany Name *Company AddressPhone *Position HeldType of Employment *Full TimePart TimeSelf-employedRetiredLength of Employment (months/years) *Monthly Gross Income (before taxes) *Did you ever declare Bankruptcy? *YesNoHave you been discharged?YesNoDate DischargedMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920How do you rate your credit?ExcellentGoodAverageBadNot sureDealership name *If you did not select a dealership yet just type "None"Have you seen the car at the dealership?YesNoIf yes, did you leave a deposit?YesNoOther Information (Including type of vehicle, question, etc.)File Upload Click or drag files to this area to upload. You can upload up to 3 files. You can submit or take a picture of any document related to your application. (Bill of sale, driver license, paystub, etc.)Terms and ConditionsPlease read the following I certify that all of the information provided by me in any credit application or other documentation given in connection with a Transaction is true, accurate, and complete in all respects. I authorize and consent to the use by Ontario Underwriters/Sam's Auto/Maximum Motor Car or their affiliates initiating, processing, or executing any transaction requested by me, and all reasonable purposes related thereto, including: a) For legal, regulatory, audit, risk assessment, processing, and security purposes (including fraud prevention); b) For purposes permitted by Canadian law or required by Canadian or applicable foreign law. c) To create aggregated and anonymous information that may be used for your business purposes; d) To conduct credit and insurance investigations concerning me from time to time in connection with a Transaction; e) To exchange my Personal information with any credit reporting agency, credit bureau, automobile or other asset insurer or aggregator of information for such insurer and/or financier in connection with considering or proceeding with a Transaction.I have read the information and hereby agree to all terms and conditions. *AgreeSubmit