Credit Application

For Your Protection

Patkar Ltd. is concerned about the security of your personal information. That is the reason we have insisted on using security measures that go beyond those used by many others. You can be assured of the following:

  • Our webserver uses a minimum of 128-bit SSL encryption, ensuring the security of your data between your computer and our webserver.
  • The moment you press "Submit Application," the information is encrypted and sent to our office. Even in this encrypted form, no personal information is saved on our website server.
  • The data remains encrypted until a special key is entered at our office to enable us to read, print and process the information.

If you have any questions or concerns, please contact us.

Vehicle of Interest

(Make/Model/Year or Stock # if known)

Buyer Personal Information

Last Name:
First Name:
Middle Name:  Suffix
Home Ph. #:  -  - 
Cellular Ph. #:  -  - 
Preferred E-Mail:
Postal Code:
Time at Address:  Yrs Mon
If less than 2 years, fill in previous address below

Previous Address:
Previous Postal Code:
Previous City/Province:
Present Res Type:
Empl. Type:
Empl. Status:
Employer Ph. #:  -  - 
Empl. Address:
Empl. Postal Code:
Empl. City/Province:
Time at Job/Time Retired: Yrs     Mon
Gross Income:
Income Interval:
Other Income Source:
Other Income Amount:
Other Income Interval
Prev. Employer:
Time at Job: Yrs     Mon
Driver's License # :
Place of Issue :
Expiry Date (MM/DD/YYYY): //

How did you hear about us? Newspaper     Radio     Word of Mouth
I affirm that the information I have given is true and correct, I authorize Patkar LTD to rely on and use this information as I am applying for a loan to purchase a vehicle from the seller (Patkar Ltd) as described in the attached bill of sale. I also agree that Patkar Ltd will be referring this application to Financial Institution(s). I agree that Patkar Ltd may obtain a credit report or other credit information from any credit reporting agency, credit bureau or credit grantor in order to determine whether credit and/or insurance will be granted to me.
Check here to affirm: