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Credit Application

Please fill out the information below and one of our representatives will contact you regarding your credit application request.

Customer Information

First Name*

Last Name*

Date of Birth*

Year

Month

Day

Email

Phone*

Address Line 1*

Address Line 2

City*

Province*

Postal Code*

Address Duration (Years)*

Address Duration (Months)*

Employment Information

Empoyer*

Employment Duration (Years)*

Employment Duration (Months)*

Gross Monthly Income*

Other Income

Disclaimer: By submitting this application, you authorize us to obtain your credit report in accordance with the provisions of the Consumer Reporting Act.

1825 N York River Rd

Warren Grove, PE, C0A 1H5

office@centralauto.ca

© 2025 Central Auto

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