Customer Automotive Loan Application

Consumer Application (Not For Dealer Use)

All fields with an asterisk * are mandatory

Full Name: As on driver's license *

First

Middle

Last

Marital Status *

Date of Birth: *

Cell Phone Number *

Email *

SIN

First

Middle

Last

Driver's license number:

Learners License? *

Current Residence

Address Type *

Home Address: (As per drivers licence.) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Years and Months at address: *

First

Last

Current Employment

Employment Status *

Occupation / Job / Employer Name *

First

Middle

Last

Employer Phone Number *

Employer Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Years with Employer *

First

Last

Finance Summary

Gross Monthly Salary *

Other Monthly Income

First

Last

Total Monthly Income *

Current Home Status

Monthly Rent / Mortgage Payment *

Mortgage

First

Middle

Last

Credit Card Type

Credit Card Number

Other Monthly Obligations

First

Last

Banking

Name

First

Last

Additional Deal Information

Monthly Payment Range *

First

Last

Down Payment Range *

First

Last

Trade In

Co-Applicant ? *

Co-Applicant Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Co-Applicant Employer (copy)

Co-Applicant Employer Cont. *

First

Last

Length of Employment *

First

Last

Gross Montly Income *

Vehicle & Deal Notes

Year: *

Make: *

Model: *

Trim:

Vin #

KMS:

Sale Price:

Any additional information important to the deal. (Carfax Link & Sales Ad Link)

Disclosure Statement: *

I/We certify all the information in this application is true and complete. I/We acknowledge the personal information gathered may be used by Rossi Financial Inc., its funders, agents and assigns, to assess my credit worthiness, provide products, administer the contract and perform services as requested by me. Rossi Financial may disclose this information to third parties such as but not limited to credit reporting agencies, financial institutions, finance companies, and my insurance agent or company. Rossi Financial may also disclose this information where required bylaw. You can withdraw this consent at any time by contacting Rossi Financial and understand this may be cause for declining your credit application. By signing below, I/We consent to these uses and disclosures and my submission is an acceptance to authorize the obtaining and release of information as it pertains to processing this credit application.

Providing a Social Insurance Number("SIN") is not mandatory. If we are unable to confirm your identity for the purpose of assessing your creditworthiness, we may request it. If declined, this may be cause for declining your Credit Application.

You certify you have requested all correspondence and Loan documentation in English.

Today's Date: *

For faster deal adjudication. Please upload driver's license and proof of income.

Click or drag a file to this area to upload.