First Name*
Middle Name
Last Name*
Month of Birth
Street Address
Postal Code
Time at this Address

Employer's Name
Time with Employer (Years)
Monthly Income (before taxes)

Vehicle of Interest
Monthly Budget

Check All that Apply

Bankruptcy Co-Signer Available 

Who is helping you right now?*
How did you hear about us?


Disclosure & Privacy Notice*

By checking this box, I consent to the collection, use and disclosure of my personal information as described in this paragraph. I agree that the personal information provided above may be used and disclosed by & EAGLE RIDGE CHEVROLET BUICK GMC LTD and/or its agents or service providers (collectively, the "Dealer") as necessary to obtain credit, financial and related personal information (including a credit or consumer information report) about me from any credit bureau or credit reporting agency, and to advise me on credit availability in connection with product and/or service purchase financing. I further agree that the personal information provided above may be disclosed to the provider of Dealer’s website hosting or related services for the purpose of enabling Dealer to access my personal information for marketing purposes. Personal information I provide and credit information obtained may also be retained by Dealer and used to facilitate the application process should I subsequently choose to apply for credit through Dealer. You can access our terms and conditions by clicking here.

 I have read and agree to the Terms and Conditions above.