Vehicle Appraisal

Personal Information
Salutationis
First Nameis required
Middle Nameis
Last Nameis required
Date Of Birthis
Marital Statusis
Social Insuranceis
Genderis
Driver's Licence No.is
Expiry Dateis
How should we reach you?
Preferred Method of Contact?

Phone Numberis
Mobile Phone Numberis
Work Phone Numberis
E-Mail Addressis required
Current Home Address
Address Typeis
Street/RR#is
Street Typeis
Street Directionis
Apt/Unit#is
Provinceis
City/Townis
Postal Codeis
Years at Address is
Months at Addressis
Housing Information
Residential Statusis
$
Market Value (if owned)Must be numeric
$
Mortgage BalanceMust be numeric
$
Monthly Rent/Mort.Must be numeric
Mortgage Co. OR Landlord Nameis
Landlord Phone No.is
Previous Home Address
Previous Address Typeis
Previous Street/RR#is
Previous Street or Station Nameis
Previous Street Typeis
Previous Street Directionis
Previous Apt/Unit#is
City/Townis
Previous Postal Codeis
Years at Previous Addressis
Months at Previous Addressis
Current Employment Information
Employment Statusis
Employment Typeis
Current Employeris
Years Employedis
Months Employedis
Occupationis
Work Contact Phoneis
Work Contact Ext.is
Address Typeis
Street/RR#is
Street or Station Nameis
Street Typeis
Street Directionis
Employer Unit#is
Postal Codeis
Current Income Information
$
Income Amount Must be numeric
Income Frequency is
$
Other Income Amount Must be numeric
Other Income Frequency is
Other Income Type is
Other Income Description is
Previous Employment Information
Previous Emp Statusis
Previous Emp Typeis
Previous Employeris
Years Employedis
Months Employedis
Previous Occupationis
Previous Work Contact Phoneis
Previous Work Contact Ext.is
Address Typeis
Street/RR#is
Street or Station Nameis
Street Typeis
Street Directionis
Employer Unit#is
City/Townis
Postal Codeis
Financing Information
$
Financed AmountMust be numeric
Termis
$
Cash DownMust be numeric
$
Monthly PaymentMust be numeric
Tell us about your Vehicle
I have a vehicle to Trade-In 
Makeis required
Modelis required
Trimis
Yearis required
KilometersMust be numeric
VINis
Colouris
Conditionis

Add A Model

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Desired Purchase
Asset Typeis
Asset Classificationis
Conditionis
Yearis
Makeis
Modelis
VIN / HIN / Serial No
Stock Number
$
OfferMust be numeric
Item Request
What type of vehicle are you looking for?
Makeis
Modelis
Trimis
Colouris
Year (Min)is
Year (Max)is
Price (Min)is
Price (Max)is
Payment Amountis
Payment Frequencyis
$
Down PaymentMust be numeric
Request Another Vehicle
Service Request
Makeis
Modelis
Yearis
Kilometers Must be numeric
                   
Service Notesis
Service Date Requestedis
Service Time Earliestis
Service Time Latestis
How did you hear about us?
Please let us know how you heard about us.
Please take a moment to tell us how you heard about us.
Referral Source (Other)is
Customer Comments
Customer Commentsis
Disclosure & Privacy Notice

By checking the box below, 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 Auto Connect Sales Inc. 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 Auto Connect Sales Inc.'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.


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


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Auto Connect Sales Inc. is committed to respecting the privacy of individuals and recognizes a need for the appropriate management and protection of any personal information that you agree to provide us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request.