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Credit Application
First Name


Last Name


Social Insurance

Date of Birth(month, day, year)
Street Address or Land Location

Street Address

Address Line 2



Postal Code

Home Telephone Number

Marital Status

How long have you lived at the above address?

Do You?

Mortgage Lender/Landlord

Monthly Payment

Balance Owed

Market Value

If you have not been at your current residence for more than 2 years please fill out the following information about your previous residence.
Previous Residence..Box #

Street Address

Address Line 2


State / Province / Region

ZIP / Postal Code


Employment and Income Information


Employer Co Name

Street Address/ Box #

How Long?

Work Telephone Number

Gross Monthly Income


Additional Monthly Income


Source of Additional Income

Vehicle Information

Vehicle Interested In


Trade Information



Serial Number

Outstanding Balance


Additional Information

Additional Notes


Form Validation


You understand and agree that you are applying for credit by providing the information to complete and submit this credit application. We may keep this application and any other application submitted to us and information about you whether or not the application is approved. You certify that the information on the application and in any other application submitted to us, is true and complete. You understand that false statements may subject you to criminal penalties.

The words “you”, “your” and “yours” mean each person submitting this application. The words “we”, “us”, “our” and “ours” as used below refer to us, the dealer, and to the financial institution(s) selected to receive your application.

You authorize us to submit this application and any other application submitted in connection with the proposed transaction to financial institutions that we have access to. This application will be reviewed by such financial institutions on behalf of themselves and us the dealer. In addition you authorize that such financial institutions may submit your applications to other financial institutions for the purpose of fulfilling your request to apply for credit.

You agree that we may obtain a consumer credit report periodically from one or more consumer reporting agencies (credit bureaus) in connection with the proposed transaction and any update, renewal, refinancing, modification or extension of that transaction. You also agree that we or any affiliate of ours may obtain one or more consumer credit reports on you at any time whatsoever.

You agree that we may verify your employment, pay, assets and debts, and that anyone receiving a copy of this is authorized to provide us with such information. You further authorize us to gather whatever credit and employment history we consider necessary and appropriate in evaluating this application and any other applications submitted in connection with the proposed transaction. You understand that we will rely on the information in this credit application in making our decision.

Ugly Trucks Unlimited Sales takes your privacy seriously and does not rent or sell your personal information to third parties without your consent.
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