|KickA$$ Credit Application Form

KickA$$ Credit Application

Please fill out the information below and either Chiara or Greg will contact you regarding your credit application request
What type of KickA$$ ride are you shopping for?*

CompactSUV or Cross OverAll Wheel DriveTruckLuxuryFully LoadedSuper Duty Truck
Desired Monthly Payment*
Monthly MAXIMUM Payment
Full Name as it appears on your driver's licence*

PrefixFirst NameMiddle NameLast Name
Your Birthdate*

MonthDayYear
Your email address*
Your Phone number*

Area CodePhone Number
Your Mobile Phone number

Area CodePhone Number
Congratulations - you are one quarter complete! Click the Next button below to continue...

KickA$$ Credit Application

Tell Us About your Current Vehicle and Financing
Do you currently have a vehicle?*

YesNo
What is the vehicle?
Make, Model, Year
Is your vehicle currently financed?

YesNo
How long have you had the vehicle?
Do you pay your loan

WeeklyBi-WeeklyMonthly
Current Payment
Please enter in your payment amount
Are you happy with your current vehicle payment?

YesNo
Congratulations, you are half way through! Press the Next button below to continue or press the Back Button to review your data.

KickA$$ Credit Application

Employment History
Name of your Current Employer as it appears on your pay cheque?
How long have you been employed with your current employer?
Years and Months
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gross Monthly Income From Employer (before taxes and deductions)
Monthly Income in dollars
If Not Employed Please Specify Other Source of Income
Do you receive monthly income from the Government?

YesNo
Monthly Income From Government or Other Source
Monthly Income in Dollars
You have almost finished!!! You only have one page left and then a quick sign-off and you are done! Click the Next Button below to continue or the Back Button to review your data.

KickA$$ Credit Loan Application

Your Current Address
Your Current Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How long have you lived at your current address?*
If less than 2 years please provide your previous address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Co Applicant Available?

YesNoMaybe
Congratulations!!! You have entered all the Data that we need to start your application. Please click on the Next Button below to sign off or click on the Back Button to review your data before signing off.

KickA$$ Credit Loan Application

Submit my Application
The information provided in this application shall not be shared to anyone else and is kept confidential
I agree that the information herein is true and correct

Yes
Should be Empty:

KickA$$ Credit Application