Sheet1 - Edmonton Truck Sales

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					                                                                            EDMONTON TRUCK SALES
                                                                        12310 66TH Street Edmonton, AB T5B 1K3
                                                                               Phone: (780) 474-2174 Fax: (780) 474-2177
                                                                                 Email: Edmontontrucksales@gmail.com
                                                                                   EDMONTONTRUCKSALES.COM

DR.          MR.          MRS.                   MISS          PROF.        SINGLE                MARRIED            COMMON-LAW                 DIVORCED         SEPERATED   WIDOWED


BUYER FULL LEGAL NAME                            SOCIAL INSURANCE NUMBER                          DATE OF BIRTH (MM/DD/YY)                      PHONE NUMBER


PRESENT ADDRESS                                  CITY                       PROV                  POSTAL CODE                                   HOW LONG?


PREVIOUS ADDRESS                                 CITY                       PROV                  POSTAL CODE                                   HOW LONG?


BUYER'S EMPLOYER                                 POSITION                                         PHONE NUMBER                                  GROSS MONTHLY INCOME


EMPLOYER'S ADDRESS                               CITY                       PROV                  POSTAL CODE                                   HOW LONG?


PREVIOUS EMPLOYER                                POSITION                                         PHONE NUMBER                                  GROSS MONTHLY INCOME


EMPLOYER'S ADDRESS                               CITY                       PROV                  POSTAL CODE                                   HOW LONG?


OTHER INCOME SOURCE                              OTHER INCOME AMOUNT                              EMAIL ADDRESS


PRIMARY BANK AND BRANCH CONTACT                                                                                      SAVINGS/CHEQUING OR CHEQUING ONLY


OWN □ LANDLORD OR MORTGAGE COMPANY                                                                PRESENT VALUE                                 BALANCE OWING                PAYMENT
RENT □
PERSONAL REFERENCE NAME CITY                                                PROV                  PHONE NUMBER                                  RELATIONSHIP TO BUYER
1)
2)
3)
HAVE YOU HAD A VEHICLE REPOSSESSED IN THE LAST 7 YEARS                                                                                                           YES    □    NO □
HAVE YOU DECLARED BANKRUPTCY IN THE LAST 7 YEARS                                                                                                                 YES    □    NO □
HAVE YOU MADE ALL YOUR PAYMENTS ON TIME IN THE LAST 7 YEARS                                                                                                      YES    □    NO □
We will protect your personal and financial information, and it is used only by and disclosed to the financial institution or chartered bank

and only to enhance products, services, and our marketing to you, and to secure credit and to support and improve total customer experience.

This includes use of personal information to:

-Understand your needs and to offer products and services meet those needs;

-Respond to your inquiries;

-Allow Clear Sky Financial and its affiliates, agents and suppliers to provide you with information relating to our/their products, services:

to obtain credit information about yourself from your employers, any credit bureau or any other person in connection with your conditional sales agreement

-Permit ongoing communications with you as our customer to ensure that you receive ongoing customer service;

-Meet safety, security, legal, regulatory and processing requirements;

PLEASE NOTE THAT BY SUBMITTING PERSONAL INFORMATION TO US, YOU CONSENT TO THE USE AND DISCLOSURE OF THIS INFORMATION FOR THE PURPOSE SPECIFIED ABOVE,

AND TO OUR PRIVACY POLICY.

BUYER'S SIGNATURE                                                                                                    DATE
                                                                                                                                                             /     /
X______________________________________________________________                                                                                 MONTH
                                                                                                                                                MONTH             DAY         YEAR

				
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posted:7/22/2011
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