Financing Application - Leisureland Camper Village

* Application Type
* First Name
* Middle Initial
* Last Name
* Social Insurance Number
* Date of Birth
* Daytime Phone
Evening Phone
Cell
Fax
* Email
Contact Me By	Phone Email Fax
	Have you been speaking to a salesperson here at Leisureland RV?
Salesperson Name

* Address
* City
* Province
* Country
* Postal Code
* Years at Address
* Months at Address

	If you have lived for less than two years at your current address, please provide your previous address below.
Address
City
Province
Country
Postal Code
Years at Address
Months at Address

* Present Employer
Work Phone Number
Occupation
* Gross Monthly Income (pre-tax)
Years with employer
	If you have worked for less than two years at your current employer, please provide your previous employer's information below.
** Previous Employer
** Years with previous employer
Other income sources
Other Gross Monthly Income (pre-tax)

First Name
Middle Initial
Last Name
Social Insurance Number
Date of Birth
Daytime Phone
Spouse's Employer
Years with Employer
	If your spouse has worked for less than two years at their current employer, please provide their previous employer's information below.
** Spouse's Previous Employer
** Years with Previous Employer
Spouse's Work Phone Number
Spouse's Occupation
Spouse Monthly Income (pre-tax)

* Homeowner Status	Own Rent
** Monthly Payment (mortgage/rent)
	If you are renting, please skip to vehicle preference below.
** Mortgage Company / Landlord
Original Mortgage Amount $
Current Mortgage Balance $
Current Home Value $

* Do you have other credit cards?	Yes No
* Primary Bank Account	Chequing Savings Joint

	What type or model of product are you looking to purchase?
Type of product
Down payment
Trade-In Model
Trade in Year
Approx. Trade in Value ($)

The undersigned acknowledges and agrees that personal information contained in this credit application or provided subsequently, and personal information obtained from a credit/consumer reporting agency and/or financial institution, as described below, may be used by, and/or collected by and/or disclosed to Leisureland Camper Village for the following purposes (i) evaluating the credit application and the undersigned's eligibility for credit, (ii) entering into a conditional sales agreement or lease agreement, (iii) contract management and administration, including for credit, billing, collection, lien registration, insurance tracking, and service and warranty purposes,(iv) marketing of vehicles and related products and services, and (v) as reasonably necessary to protect the business interests of Leisureland Camper Village and its customers. Please initial at the end of this sentence if the undersigned does not consent to Leisureland Camper Village using and/or disclosing personal information for marketing purposes.

The undersigned acknowledges and agrees that personal information may be transferred to a third party or parties to be used for the same purposes described herein if the conditional sales agreement or lease agreement entered into by the undersigned is transferred or assigned to such third party or parties, or to an organization in connection with the due diligence for, and completion of, a business transaction, including, without limitation, a securitization or financing involving Leisureland Camper Village.

It is the express wish of the parties that this form and any related documents be drawn up and executed in English. Les parties ont expresserrient exiqe que Ie present formulaire et tous les documents s'y rattachant soient rediges en anglais.

The undersigned further acknowledges and agrees, in connection with Leisureland Camper Village making a determination in respect of this credit application, that (a) all information provided in this application is for the purpose of securing credit and warrants that it is true, correct and complete, (b) a credit/consumer report and other credit information containing personal information may be requested from a credit/consumer reporting agency and financial institution, (c) Leisureland Camper Village is authorized to exchange with any credit/consumer reporting agency and financial institution credit information covering this application and details of any credit granted (including, without limitation, payment history relating to the credit granted) for the purposes of Leisureland Camper Village determining creditworthiness and for the purposes of permitting other credit grantors to do the same. The undersigned may request Leisureland Camper Village to inform the undersigned whether or not a credit/consumer report has been or may be referred to in connection with this transaction, and the undersigned may request the name and address of the credit/consumer reporting agency supplying the credit/consumer report.