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Application for financing
Fax this form to 613-745-7352
Applicant's Name (first, middle, last):   _____________________________________
Date of Birth: ______________ Social Ins. #: ____________________
Street Address: ______________   Home Phone #: ____________________
City: ______________   Province: ____________________
Postal Code:     Time at Address:
_______ Yrs _______ Mos
No. of Dependants: ______________   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    No
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 #: ______________   E-mail Address: ____________________
X________________________________   X___________________________________
Signature of Applicant                      Date Signature of Co-Applicant                      Date
Driver's License #:__________________   Driver's License #:_____________________
or Other Identification (Type and #):   or Other Identification (Type and #):
_________________________________   ____________________________________