A-Factor Enterprises

Submit the application form below and A-Factor will attempt to match you with a lender that best suits your financial needs.

This form uses industry-standard data encryption technology to ensure the safety of your data. If you'd still prefer not to submit your information online, click here for a printable Adobe PDF version of our application form that you can fax to us. Or, you can give us a call at 306-761-2277 to apply.

Fields marked with a red asterisk (*) are required.

* First Name:
* Middle Name:
* Last Name:
Age:
* Birth Date:
Marital Status:
Address:
City/Town:
Province:
* Postal Code:
Previous Address: *If you've been at current residence for less than 2 years.
Home Phone:
Work Phone:
Cell Phone:
E-mail Address:
SIN Number: *Not required, but it will speed up your application.
Present Employer:
Occupation:
Length of time in current occupation:
* Gross Monthly Income:
Monthly Rent or Mortgage:
Have you declared bankruptcy in the last 7 years?
Have you ever had a vehicle repossessed?
Do you have a co-signer available for your financing?
How would you rate your credit?
Vehicle Desired #1:
Vehicle Desired #2:
Approximate kilometers driven per year:
Down Payment Amount:
Do you have a vehicle you'd like to trade in?
If yes, tell us about your trade-in:	Year: Make: Model: Kilometers: Amount Owing: Owed to:
Comments:
Have a promo code? Enter it here: If you don't have one, leave field marked as "xxx".
I, * authorize A-Factor Enterprises Inc. and/or any auto dealers who A-Factor Enterprises Inc. works on behalf of to collect, use and disclose personal information for the following purposes: to provide goods and services as may be requested by you; to provide more infromation about our products and services, or those of our affiliates, and business partners; generate statistical and aggregated data that does not identify you personally; to disclose your personal information to our service providers and affiliates for the purpose of providing services to you, obtaining financing on your behalf, and to provide more information regarding their products and services. to establish and maintain responsible commercial relations with you and to provide ongoing services; to manage and develop our business and operations; to meet legal and regulatory requirements; to evaluate your creditworthiness or to collect your account; for such other purpose as may be determined by us, acting reasonably, or as is otherwise authroized or required by law; I understand that I may decline or object to having my personal information collected, used or disclosed for the above purposes. I also understand that I revoke this consent at any time by submitting a written notice. * I agree. "I agree" must be checked for this application to be processed!