Car Loan Application

Virden Mainline Motor Products Ltd

This application will be sent to Virden Mainline Motor Products Ltd.

Please fill in the form below to pre-qualify for a car loan.
You can also call and apply over the phone (204) 748-3811 if you feel more comfortable.

First Name *

Last Name *

Please fill in your first name, and last name.

Social Insurance Number *

Date of Birth *

Please fill in your social insurance number, and select your date of birth.

Contact Info

Your E-mail *

Please fill in your email.

Best Time to Call *

Home Phone * (

)

Please select the best time for us to reach you, and fill in your home phone number.

Mobile Phone (

)

Work Phone (

)

Please fill in your mobile phone number, and work phone number. These fields are optional.

Current Residence

Address *

City *

Please fill in your current hone address, and city of residence.

Postal Code *

Province *

Please fill in your postal code, and select your province of residence.

Home Status *

Living at current Location for *

Please select your current home status, and length at residence.

Current Employer

Employment Type *

Employment Status *

Please select your current employment type, and employment status.

Employer *

Occupation *

Please fill in who you are currently employed by, and your occupation.

Gross Monthly Income *

Working at current job for *

Please fill in your current gross monthly income (before tax), and select length at current job.

Some Final Questions...

Have You Ever Declared Bankruptcy? *

Yes No

Is a Cosigner available if needed? *

Yes No

I authorize you to run my credit report *

Yes No