Western Auto Sales Online Credit Application

Applying Online

Western Auto Sales is committed to keeping your information private and secure. This online application form uses SSL encryption to ensure you data is not viewable to others when it is submitted. Please review our privacy policy to ensure you are in agreement with our policy to keep your information private.

I am interested in a

* Denotes required information.

How Did You Find Us?

Western Auto Sales strives to be the best in customer service. To help us better serve you, we'd like to know how you found us!  Please check a box that best applies to how you found your way to www.westernautosales.ca:

Internet search
Friends or Family
Radio Advertising
TV Advertising
Print Advertising

 Personal Information

First Name *


Last Name *


Home Phone *(999-999-9999)

Work Phone(999-999-9999)

Cell Phone

Birth Date (use calendar)

Number of Dependants

Marital Status

SIN (eg. 123456789 - no space)

Address Information

Current Address



Postal Code (eg. A1B2C3)
Time at this Address: Year(s) Month(s) Rent Own  
If you own a home please indicate:
Current Value: $
(eg 3000, 303.44, No comma)
Purchase Price: $
(eg 3000, 303.44, No comma)
Balance Owing: $
(eg 3000, 303.44, No comma)
Landlord Mortgage Holder:
Monthly Payment on Rent or Mortgage: $
(eg 3000, 303.44, No comma)
Landlord Phone Number:
Please provide your previous address below:
Previous Address Previous City
Previous Province: Length at Previous Address Year(s) Month(s)

Previous Postal Code (eg. A1B2C3)

Previous Rent Amount
(eg 3000, 303.44, No comma)

 Employment Information



Employer Address
Year(s) Month(s)
Time Employed

Phone (999-999-9999)


Postal Code (eg. A1B2C3)

Contact Person
Please input your previous employer below:


Years Months
Time Employed

 Financial Information

Gross Monthly Income: $
(eg 3000, 303.44, No comma)
Additional Income: $
(eg 3000, 303.44, No comma)
Cash Available for Down Payment: $
(eg 3000, 303.44, No comma)
Source of Additional Income:
Maximum Affordable Monthly Payment: $
(eg 3000, 303.44, No comma)
Have you been to Collections or Bankruptcy? Yes No
Bankruptcy Discharge Date:
(use calendar)
Bankruptcy Trustee:

Driver Information

Do you have a drivers license? Yes No
If YES, please indicate your license class:
If NO, please explain who will be driving your vehicle:

I/we certify that each of the statements made and answers given in this credit application are true and correct and is made for the purpose of inducing the financing of the purchase of a motor vehicle. I/we authorize the obtaining of a consumer report to be used in evaluating this application and the obtaining and exchanging of credit information from and with other creditors and consumer reporting agencies.

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