Dan The Money Man /

PH 705-730-0011 FAX 705-727-0320

Mobile: 416-931-2692

Email:

/ Credit Application
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B / BUSINESS NAME/LESSEE / PHONE / FAX / CELL
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S / ADDRESS (STREET) / CITY / PROV
SelectABBCMBNBNLNSNTNUONPEQCSKYT / POSTAL CODE / EMAIL ADDRESS
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N / TYPE OF BUSINESS / YRS & MONTHS UNDER CURRENT OWNERSHIP / MONTH/ YEAR COMMENCED
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S / LOCATION OF EQUIPMENT (STREET) / CITY / PROV
SelectABBCMBNBNLNSNTNUONPEQCSKYT / POSTAL CODE / PROV OF INCORPORATION
S / Business Structure / Provincial Corp Federal Corp. Partnership Sole Proprietorship Public Stock Ticker:
O / PRINCIPAL’S NAME / TITLE / % OWNERSHIP / DATE OF BIRTH ( M / D / Y) / SIN:
WN / HOME ADDRESS ( #, STREET, CITY, PROV, / POSTAL CODE) / HOME PHONE NO. / OWN
RENT
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R / PRINCIPAL’S NAME / TITLE / % OWNERSHIP / DATE OF BIRTH ( M / D / Y) / SIN:
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H / HOME ADDRESS ( #, STREET, CITY, PROV, / POSTAL CODE) / HOME PHONE NO. / OWN
RENT
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P / PRINCIPAL’S NAME / TITLE / % OWNERSHIP / DATE OF BIRTH ( M / D / Y) / SIN:
HOME ADDRESS ( #, STREET, CITY, PROV, / POSTAL CODE) / HOME PHONE NO. / OWN
RENT
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A / BANK / DEALING SINCE / CONTACT / TELEPHONE / FAX
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K / BRANCH / CHECKING ACCT. NO. / OPERATING LOAN AMOUNT AUTHORIZED $ / AVG. AMOUNT UTILIZED
C / YOUR THREE LARGEST CUSTOMER NAMES / THEIR LOCATION / % OF YOUR ANNUAL SALES / HOW LONG DEALING
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E
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YOUR THREE LARGEST TRADE SUPPLIERS / TELEPHONE NO. / AVERAGE AMOUNT OWED / HOW LONG DEALING
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A
D
E
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U / VENDOR / MY CONTACT
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C / ADDRESS (STREET / CITY / PROV / POSTAL CODE / TELEPHONE
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A / EQUIPMENT TO BE LEASED
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E / COST OF EQUIPMENT
$
$ / PREFERRED TERM
36 48 60 72 / PREFERRED LEASE END OPTON
$1.00 FMV 10% PURCHASE / VENDOR PAYMENT TERMS / PREFERRED MONTHLY PMT
$
By signing this form, the signor (s), who is a principal of the credit applicant, confirms that the information you have given us in respect of this application is true and complete, and you authorize us to rely on and use this information in order to confirm your identity, evaluate your credit worthiness, in relation to the financing transaction being contemplated. In particular, you agree that we, our affiliates and any third parties acting for us or on our behalf (hereinafter collectively “us”, “we” or “our”), may obtain a credit report or other credit information from any credit reporting agency, credit bureau or credit grantor, and may hold, use, exchange and disclose such information for the purposes identified above.
If your application is approved, you authorize us to collect, hold, use, exchange and disclose your personal information as required, in order to administer your contract, determine your insurance eligibility, and secure the assets being financed, or as required or permitted by law. You also authorize us to use your personal information for internal statistical analysis purposes.
We will keep a file containing some or all of your personal information at our Head Office Location from time to time. You have a general right to access and rectify the personal information in this file by making a written request to us, Attention: Privacy Office. /
All owners MUST sign
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SIGNATURE /TITLE DATE
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SIGNATURE /TITLE DATE
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SIGNATURE /TITLE DATE
Use separate authorization if needed