Miedemas Auto Sales


Call: 519-940-3766

Financing

Get Approved For Financing Now! Fill out the application below (This form is secured by SSL for your ssl verificationprotection).

 

First Name *

Last Name *

Home Address *

City *

Province *

Postal Code *

Home Phone

Your Email *

Date of Birth*

Home Status

Years at Present Address:

EMPLOYMENT INFORMATION

Employer:

Employer Address:

Employer Phone:

Occupation:

Years Employed:

Gross Monthly Salary:

Total Monthly Payments:

Have you Declared Bankruptcy in the Past 7 Years?
YesNo

Is a co-signer available if needed?
YesNo

Do you Have a Downpayment?
YesNo

S.I.N. Number:

Drivers License Province of Issue:

Drivers License Class:

Drivers License Number:

Drivers License Expiry

Notes:

Describe the type of vehicle you wish to purchase