Applicant Information Name * First Name Last Name Date of Birth * MM DD YYYY Phone * (###) ### #### Email * SIN# * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country How Long Have You Lived at the above Address * Marital Status * Married Divorced Separated Single Common Law Widowed Current Employer * Job Title Current Monthly income Before Taxes $ Additional Monthly Income I agree to sending this information * By checking this box, 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 CITTA AUTO 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 Dealer’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 I constant to receive commercial electronic messages Thank you!We will get back to you shortly