|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? *

Compact SUV or Cross Over All Wheel Drive Truck Luxury Fully Loaded Super Duty Truck
Desired Monthly Payment *
Monthly MAXIMUM Payment
Full Name as it appears on your driver's licence *

Prefix First Name Middle Name Last Name
Your Birthdate *

Month Day Year
Your email address *
Your Phone number *

Area Code Phone Number
Your Mobile Phone number

Area Code Phone 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? *

Yes No
What is the vehicle?
Make, Model, Year
Is your vehicle currently financed?

Yes No
How long have you had the vehicle?
Do you pay your loan

Weekly Bi-Weekly Monthly
Current Payment
Please enter in your payment amount
Are you happy with your current vehicle payment?

Yes No
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

City State / 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?

Yes No
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

City State / Province

Postal / Zip Code Country
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

City State / Province

Postal / Zip Code
Co Applicant Available?

Yes No Maybe
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