28NOV201211093145 CONSUMER CREDIT APPLICATION

[Pages:1]28NOV201211093145

CONSUMER CREDIT APPLICATION

DEALER TO

COMPLETE

Dealer Number

NEW/DEMO USED

Dealer Name

LEASE CONDITIONAL SALE

GRADUATE PROGRAM

FUTURE VALUE PURCHASE PROGRAM

Year

Make

INDIVIDUAL BOTH TO SIGN

Model Code

PLEASE PRINT

Applicant Mr. Ms.

Current Address

Last Name Number and Street

First Name

Apt. Number

City

Middle Name Province/Territory

Postal Code

Previous Address (if less than 3 years at Current Address) Current Employer Name and Address

Business Phone Number

Previous Employer Name and Address (if less than 3 years at Current Employer)

Co-Applicant Mr. Ms.

Current Address

Last Name Number and Street

First Name

Apt. Number

City

Middle Name Province/Territory

Postal Code

Previous Address (if less than 3 years at Current Address) Current Employer Name and Address

Business Phone Number

Previous Employer Name and Address (if less than 3 years at Current Employer)

Email Address Applicant Co-Applicant

Applicant Gross Monthly Salary $

Co-Applicant Gross monthly Salary $

Financial Institution

Name

Address

Other Income $

Cellular Phone Number Applicant Co-Applicant Describe Other Income

Phone Number

Landlord/Mortgage Holder Own Rent

Name

Relative Not Living With Applicant

Personal Reference Not Living With Applicant

Principal Driver's Name

Address

Name Name

Address Address

Phone Number

Applicant S.I.N. (Optional) Home Phone Number

Trade/Occupation Trade/Occupation Applicant S.I.N. (Optional) Home Phone Number

Trade/Occupation Trade/Occupation

Date of Birth MM DD YY

Length Yrs. Mths.

Number of Years

Length Yrs. Mths.

Number of Years

Date of Birth MM DD YY

Length Yrs. Mths.

Number of Years

Length Yrs. Mths.

Number of Years

Account Number Monthly Rent Pmt. $

Relationship to Applicant

Driver's Licence Number

Total Income $

Savings Chequing

Monthly Mortgage Pmt. $

Home Phone Number

Home Phone Number

The undersigned acknowledges and agrees that personal information in this credit application or provided subsequently, and personal information obtained from a credit/consumer reporting agency and/or financial institution, as described below, may be used by, collected by and/or disclosed to Honda Canada Finance Inc., operating as Acura Financial Services (hereinafter ``AFS'') (including Canadian and foreign subsidiaries, affiliates, agents and contractors of AFS as well as the authorized dealer named above or any other authorized dealer(s) designated by AFS) for the following purposes: (i) completing my purchase, finance or lease transaction; (ii) maintaining the undersigned's warranty and customer service records; (iii) conducting customer service campaigns; (iv) providing the undersigned with marketing information; (v) evaluating the undersigned's credit application and eligibility for credit; (vi) contract management and administration; (vii) collections, lien registrations and insurance purposes; and (viii) for legal and other business purposes. The undersigned can contact Acura Financial Services at 1-866-899-4440 or 180 Honda Boulevard, Markham, Ontario, L6C 0H9, and the undersigned's Dealer if the undersigned no longer consents to these uses and to update or correct the undersigned's personal information.

The undersigned acknowledges and agrees that personal information may be transferred to a third party or parties to be used for the same purposes described herein if the conditional sales agreement or lease agreement entered into by the undersigned is transferred or assigned to such third party or parties, or to an organization in connection with the due diligence for, and completion of, a business transaction, including, without limitation, a securitization or financing involving AFS or its subsidiaries or affiliates. It is the express wish of the parties that this form and any related documents be drawn up and executed in English. Les parties ont expresse?ment exige? que le pre?sent formulaire et tous les documents s'y rattachant soient re?dige?s en anglais.

The undersigned further acknowledges and agrees, in connection with AFS making a determination in respect of this credit application, that (a) all information provided in this application is for the purpose of securing credit and warrants that it is true, correct and complete, (b) a credit/consumer report and other credit information containing personal information may be requested from a credit/consumer reporting agency and financial institution, (c) AFS is authorized to exchange with any credit/consumer reporting agency and financial institution credit information covering this application and details of any credit granted (including, without limitation, payment history relating to the credit granted) for the purposes of AFS determining creditworthiness and for the purposes of permitting other credit grantors to do the same. The undersigned may request AFS to inform the undersigned whether or not a credit/consumer report has been or may be referred to in connection with this transaction, and the undersigned may request the name and address of the credit/consumer reporting agency supplying the credit/consumer report.

Applicant Signature HCFI (06/2014) AFS CCA NTL ? E (AUTO)

Date

Co-Applicant Signature

Date

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