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LOAN INFORMATION

Purpose Of Loan:

Purchase Price/Loan Value:

Type of Loan:

Amount of Downpayment:

Closing Date:

BORROWER INFORMATION

*First Name:

*Last Name:

Mailing Address:

City:

Prov: Postal:

*Daytime telephone:

Extension:

Home telephone:

E-mail address:

Employer Name:

# of Years:

Gross Annual Income:

SIN# (optional):

Date of Birth:

CO-BORROWER INFORMATION

First Name:

Last Name:

Mailing Address:

City:

Prov: Postal:

Daytime telephone:

Extension:

Home telephone:

E-mail address:

Employer Name:

# of Years:

Gross Annual Income:

SIN# (optional):

Date of Birth:

OPTIONAL INFORMATION

How do you wish
to be contacted?

How did you hear about us?:

Comments"

*I/We warrant and confirm that the information given in the mortgage application form is true and correct and I/We understand that it is being used to determine my/our credit responsibility. You are authorized to obtain any information you may require relative to this application from any sources to which you may apply and each such source is hereby authorized to provide you with such information. You are furthermore authorized to disclose, in response to direct enquiries from any other lender or credit bureau, such information on my loaning account as you consider appropriate, and I agree to indemnity you against and save you harm from any and all claims in damages or otherwise arising from such disclosure on your part. You are also authorized to retain the application whether or not the relative mortgage is approved. *Terms and conditions apply. *Rate subject to change.