PLEASE COMPLETE THE APPLICATION FORM IN FULL:

PERSONAL INFORMATION

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Gender



Marital Status




Home Status



EMPLOYMENT INFORMATION

Is a Cosigner available?



COSIGNER INFORMATION

Have you ever declared bankruptcy?



I have read the information below and hereby agree to all terms and conditions.


Email or Fax 1-844-300-6500  the Bill of Sale now.

PLEASE READ THE FOLLOWING TERMS AND CONDITIONS              

  I certify that all of the information provided by me in any credit application or other documentation given in   connection with a transaction is true, accurate, and complete in all respects.  I authorize and consent to the use by Trillium Underwriters Inc. or their affiliates initiating, processing, or executing any transaction requested by me, and all reasonable purposes related thereto, including:  a)  For legal, regulatory, audit, risk assessment, processing, and security purposes (including fraud prevention); b)  For purposes permitted by Canadian  law or required by Canadian or applicable foreign law. c)  To create aggregated and anonymous information that may be used for your business purposes;  d) To conduct credit and insurance investigations concerning me from time to time in connection with a transaction; e)  To exchange my personal information with any credit reporting agency, credit bureau, automobile or other asset insurer or aggregator of information for such insurer and/or financier in connection with considering or proceeding with a transaction.