Request Credit Online from Upper Island Motors in Courtenay, British Columbia

Request Credit

Please fill out the following Credit Application, click "Click to Send Info" and we'll get back to you as soon as possible. Click here for a simple contact form.


Personal Information
First Name
Last Name
Middle Initial
Social Insurance Number
Date of Birth
Street Address
City
Province
Postal Code
Phone Area Code
Daytime Phone
Evening Phone
FAX
E-Mail

Own or Rent
Type of Residence
How Long at this Residence
Landlord / Mortgager Name
Landlord / Mortgager Phone
Monthly Payment $

Employment Information
Employer
Work Phone
Your Position
How Many Years
Gross Monthly Income $
Other Income $
Source of Other Income

*Spouse's or Cosigner's Information*
First Name
Last Name
Middle Initial
Social Security Number
Date of Birth
Street Address
City
Province
Postal Code
Phone Area Code
Daytime Phone
Evening Phone
FAX
E-Mail

Type of Residence
How Long at this Residence
Monthly Payment $

*Spouse's or Cosigner's Employment*
Employer
Your Position
How Many Years
Gross Monthly Income $
Other Income $
Source of Other Income

*Financing Information*
Trade or Down Payment $
Preferred Monthly Payment $
Purchase Lease How Long

Vehicle Currently Considering or Looking for
MODEL
Year

*Trade-In Information*
Make
Model
Year
Colour
How many true KM's
Number of doors
Loan balance $
Lien Holder's name
Comments

By clicking “Submit Info” you submit and certify that all of the information provided by you in this application is about you, is true and correct and made for the purpose of obtaining credit for you. You also certify that you have read the Privacy Policy and therefore authorize us to use your information in processing your credit application.