Pioneer Motor Products Ltd. - Online Credit Application

PIONEER MOTOR PRODUCTS LTD.

902 - 7th Avenue East

Box 1625

Melville, Saskatchewan

Canada S0A 2P0

C/O Myron Trafananko

306-728-4950 bus/res/msg

306-728-4488 bus2

306-728-2277 fax

306-728-7662 cel/msg

Website

http://www.pioneermotorproducts.com

Email

Click the link to

Online Credit Application Form

	Personal Information
1	First Name
2	Middle Name
3	Surname
4	Date of Birth [MM][DD][YYYY]
5	Social Insurance Number
6	Street Address
7	Mailing Address
8	City
9	Province
10	Postal Code
11	Time Lived Here [YY][MM]
12	Telephone Number
13	Cellular Number

	Employment and Income Information
14	Employer Name
15	Occupation
16	Employer Telephone Number
17	Time At Current Employer [YY][MM]
18	Gross Income	--
19	Trade In
20	Down Payment - Down Payment Amount

	Prospective Purchase - Vehicle - Inventory Item
21	Item Description (eg year, make, model)

Enter Any Other Information / Questions