Good Credit? Bad Credit? WE CAN HELP!
Buying a pre-owned vehicle at selectiCar can help you re-establish your credit!
Personal Information
Salutation is
First Name is required
Middle Name is
Last Name is required
Date Of Birth is
Marital Status is
Social Insurance is
Gender is
Driver's Licence No. is
Expiry Date is
How should we reach you?
Please choose preferred method of contact:

Home Phone Number is
Mobile Phone Number is
Work Phone Number is
E-Mail Address is required
Current Home Address
Address Type is
Street/RR# is
Street or Station Name is
Street Type is
Street Direction is
Apt/Unit# is
City/Town is
Postal Code is
Years at Address is
Months at Address is
Housing Information
Residential Status is
$
Market Value (if owned) Must be numeric
$
Rent/Mortgage per month Must be numeric
Mortgage Company OR Name of Landlord is
Landlord Phone No. is
Previous Home Address
Previous Address Type is
Previous Street/RR# is
Previous Street or Station Name is
Previous Street Type is
Previous Street Direction is
Previous Apt/Unit# is
City/Town is
Previous Postal Code is
Years at Previous Address is
Months at Previous Address is
Current Employment Information
Employment Status is
Employment Type is
Current Employer is
Years Employed is
Months Employed is
Occupation is
Work Contact Phone is
Work Contact Ext. is
Address Type is
Street/RR# is
Street or Station Name is
Street Type is
Street Direction is
Employer Unit# is
Postal Code is
Current Income Information
$
Income Amount Must be numeric
Income Frequency is
$
Other Income Amount Must be numeric
Other Income Frequency is
Other Income Type is
Other Income Description is
Previous Employment Information
Previous Emp Status is
Previous Emp Type is
Previous Employer is
Years Employed is
Months Employed is
Previous Occupation is
Previous Work Contact Phone is
Previous Work Contact Ext. is
Address Type is
Street/RR# is
Street or Station Name is
Street Type is
Street Direction is
Employer Unit# is
City/Town is
Postal Code is
Financing Information
$
Financed Amount Must be numeric
Term is
$
Cash Down Must be numeric
$
Monthly Payment Must be numeric
Tell us about your Vehicle
Make is
Model is
Trim is
Year is
Kilometers Must be numeric
VIN is
Colour is
Condition is
Desired Purchase
Asset Type is
Asset Classification is
Condition is
Make is
Model is
Year is
VIN / HIN / Serial No
Stock Number
$
Offer Must be numeric
What type of vehicle are you looking for?
Make is
Model is
Trim is
Colour is
Year (Min) is
Year (Max) is
Price (Min) is
Price (Max) is
Payment Amount is
Payment Frequency is
$
Down Payment Must be numeric
Request Another Vehicle
Service Request
Year is
Make is
Model is
Kilometers Must be numeric
Please Select Service Items Required: is
Service Notes is
Service Date Requested is
Service Time Earliest is
Service Time Latest is
How did you hear about us?
Please take a moment to tell us how you heard about us.
Referral Source (Other) is
Customer Comments
Customer Comments is
Disclosure & Privacy Notice

By checking the box below, I consent to the collection, use and disclosure of my personal information as described in this paragraph. I agree that the personal information provided above may be used and disclosed by Clonsilla Auto Sales & Leasing and/or its agents or service providers (collectively, the "Dealer") as necessary to obtain credit, financial and related personal information (including a credit or consumer information report) about me from any credit bureau or credit reporting agency, and to advise me on credit availability in connection with product and/or service purchase financing. I further agree that the personal information provided above may be disclosed to the provider of Clonsilla Auto Sales & Leasing's website hosting or related services for the purpose of enabling Dealer to access my personal information for marketing purposes. Personal information I provide and credit information obtained may also be retained by Dealer and used to facilitate the application process should I subsequently choose to apply for credit through Dealer.


I have read and agree to the Terms & Conditions above.

Add Co-Applicant
Yes! I would like to receive special offers and deals from Clonsilla Auto Sales & Leasing.
Please uncheck this box if you do not wish to receive future emails from us.