ARL Application – Auto Repair Loans

Vehicle Owner Application

Step 1 of 3 - Vehicle Owner Info progress

First Name*

Middle Name

Last Name*

Address*

City & province*

Postal Code*

Are you over 19?*

Is the vehicle free of all financial obligations?*

If No: Why?

Are you the sole owner?*

If No: Name of other?

How much cash do you require?*

Repair or Customization needed?

Step 2 of 3 - Vehicle Owner Info progress

Insurance No

Plate

Vin*

Make*

Model*

Trim*

Year*

Color*

Odometer*

Transmission*

Do you have a spare key?

Any external damage in excess of $2000 or has a rebuilt engine?*

Any current damages on the vehicle?*

Overall condition of the vehicle? Very GoodGoodFairPoor

Is there collision insurance coverage on the vehicle?*

How much is the collision deductible?

Insurance expiry Date:*

Step 3 of 3 - Vehicle Owner Info progress

Driver license No.*

Province

Expiry Date*

Date of Birth

Home Phone

Email*

Cell*

Work Phone

Employer

Marital Status

Job Title

Address of Employer

Spouse/Partner's Name

Spouse/Partner's Address if different from yours

Phone