Yamaha Bikes, Yamaha Parts, Motorcycles, Peterborough Power Sports 705-742-2404

Credit Application

Name (First, Last) *		Gender
SIN	Date of Birth	e-mail
City
Postal Code	Province
Residence Status (own, rent, other)	Years at Residence	Phone
Previous Address if applicable
Address
City	Postal Code	Province
Employer		Phone
Occupation
Years at current employer	Gross Annual Income	Spousal Income
Bankruptcy	Credit Card	Expiry Date
Total Monthly Payments	Monthly Residence Costs	Other Monthly Obligations
Co-Applicant
Name (First, Last) *		Gender
SIN	Date of Birth	e-mail
Address
City	Postal Code	Province
Residence Status (own, rent, other)	Years at Residence	Phone
Previous Address if applicable
Address
City	Postal Code	Province
Employer		Phone
Occupation
Years at current employer	Gross Annual Income	Spousal Income
Bankruptcy	Credit Card	Expiry Date
Total Monthly Payments	Monthly Residence Costs	Other Monthly Obligations

Consent
I consent to the Peterborough dealer to collecting personal information set out above and to disclose it to GHR Systems Inc. and to HSBC RetailServices Limited. I authorize GHR Systems Inc. and HSBC Retail Services Limited to obtain factual and investigative information regardingmyself from others as permitted by law, and to furnish other credit grantors and credit reporting agencies with particulars of this creditapplication and subsequent credit experience.
Signature (applicant)		Date
Signature (co-applicant)		Date