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We offer financing to customers on approved credit, such as six months deferred financing, twelve or twenty-four equal payments with no interest and up to 4 year repayment programs. Please fill out the following form online or print it and fax it to us at 613-745-7352. A representative from our company will contact you within one business day to confirm the request. Please enter all information on this form to ensure your application is processed properly.

* Applicant's Name (first, middle, last):

Date of Birth:

Social Ins. #:

Street Address:

* Home Phone #:

City:

Province:

Postal Code:

Time at Address:

Yrs

Mos

Email:

No. of Dependents:

Monthly Rent or Mortgage Payment:

Applicant:

Rents

Owns/Buying

Other

If applicant owns or is buying:

Applicant has:

Current Home Value:

	Chequing Acct(s).	#
	Savings Acct(s).	#

Mortgage Balance:

Employer:

How Long:

Yrs

Mos

Position:

Gross Salary:

Per

Work Phone #:

Other Income (Income from spousal support, child support, or separate garnishment payments need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.)

Has applicant ever declared bankruptcy:

Yes

Landlord/Mortgage Holder:

Previous Address
(if less than 2 yrs. at current address):

Previous Employer:

How Long:

Yrs

Mos

Position:

Gross Salary:

Per

Work Phone #:

Co-applicant's Name (first, middle, last):

Social Ins. #:

Date of Birth:

Current Street Address (if different from applicant):

City:

Province:

Postal Code:

Home Phone #:

Co-applicant's Employer:

How Long:

Yrs

Mos

Position:

Salary:

Per

Work Phone #:

Nearest relative not living with you:

Relationship:

Name:

Street Address:

City:

Province:

Postal Code:

Phone #:

Email: