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HOUSE OF NISSAN

3620 VICTORIA AVE.
PH:1(204 )727-6418    -    FAX:1(204)727-2082
TOLL FREE - 1-866-723-0898
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Complimentary Wireless Internet
Access in our Customer Lounge

 
Bad Credit - No Problem: Please fill out our Application Form and We Will Help Put You in the Car of Your Choice. Please be sure to fill out every question so that we can do the best job for you.
 
Step 1 - Applicant Information   *Required Fields

Please fill out the information required to contact you.
First Name:* Last Name:*
Address:*
City:*
Province:* Postal Code:*
E-Mail:*
Telephone:* ( ) - (day)
Telephone: ( ) - (evening)
How long have you been at your current address?*
Rent Or Own Monthly Payment?*
Social Security Number:* Date Of Birth:*
Current Employer:*  How Long?*
Gross Income:* Pay Period:*
 
Step 2 - About Your New Vehicle
What Monthly Payment Fits Your Budget?*
How much will you be able to put down on your new vehicle?*
Comments - What kind of vehicle are you looking for, any special circumstances?
 
Step 3 - Co-Applicant Information (Only if applicable)
First Name: Last Name:
Address:
City:
Province: Postal Code:
E-Mail:
Telephone: ( ) - (day)
Telephone: ( ) - (evening)
How long have you been at your current address?
Rent Own Monthly Payment?
Social Security Number(no spaces): Date Of Birth:
Current Employer:  How Long?
Gross Income: Pay Period:
 
Step 4 - Authorization 
By clicking on "Submit", I acknowledge and declare that I have read and agree with the Application Disclosure. I certify that I have provided complete and true information in the application. I allow DAVE CREIGHTON to investigate my credit:*
 
 
When you submit this form you give HouseofNissan.ca full authorization to investigate your credit history.