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Apply Online Today - Quick and Easy Mortgage Application
   

BUSINESS LEASE CREDIT APPLICATION

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You are now using a secure web server for this transaction.


Please fill out this application and submit it for approval. Please fill in this form completely, if sections or fields are missed, this could slow down the approval process.

If you would rather print off this form and fax it to Stacey & Dan's office, please CLICK HERE to download a .PDF file. Print this file and fill out all fields completely and accurately. Then fax it to 1-866-902-4910.

* email address is required

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General Information

Referrer Name
Equipment Supplier
Term Requested
Amount $
Code
Equipment
    New     Used
Contact
Phone
Fax
Email
   

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Company Information

Business Legal Name
Operating As
Phone
Address
City
Province
Postal Code
Fax
Description of Business
Contact
Email
Business Start Date
Structure
Incorporated      Partnership      Proprietorship      Other
Location of Equipment
Same as Above
Actual Equipment Location (If different)
Address
City
Province
Postal Code
   
Insurance Broker
Contact
Phone
Fax
   
Landlord
Contact
Phone
Fax
   

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Principles of the Company

Legal Name
Title
Interest in Balance (%)
SIN#
Date of Birth
Address
City
Province
Postal Code
Phone

Legal Name
Title
Interest in Balance (%)
SIN#
Date of Birth
Address
City
Province
Postal Code
Phone
 

CONSENT FORM
PLEASE READ BEFORE SUBMITTING APPLICATION

Show/ Hide Consent Form

I/we confirm that the information in the business lease application form is true and complete and I/we authorize you to rely on and use this information in order to confirm my/our identity and evaluate my/our credit worthiness, in relation to the financing contract being entered into. In particular, I/we agree that you, your affliates and any third parties acting for you or on your behalf, 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 my/our application is approved, I/we authorize you to collect, hold, use, exchange and disclose my/our personal information, as required, in order to administer my/our contract, determine my/our insurance eligibility, and secure the assets being financed, or as required or permitted by law. I/we also authorize you to use my/our personal information for internal statistical analysis purposes.

A file containing some or all of my personal information will be kept at 55 Administration Road, Suite 11, Vaughan, Ontario, L4K 4G9 from time to time. I/we have a general right to access and rectify the personal information in this file by making a written request to the above address, Attention: Privacy Office.

 
I AGREE to the Consent Form.        
I DO NOT AGREE to the Consent Form.
 

Dan Mass/Verico Canada First Mortgage: In Partnership with Alliance Capital Partners


DAN MASS, Mortgage Broker
Box 32 Site 15 RR9 Calgary, Alberta, Canada  T2J 5G5
direct: 403.294.0033  toll free: 1-888-894-0033
cell:
403.710.1505 fax: 1-866-902-4910
email: dan@canadafirstmortgage.com

STACEY MASS, Mortgage Agent
Box 32 Site 15 RR9 Calgary, Alberta, Canada  T2J 5G5
direct:
403.294.0033 toll free: 1-888-894-0033
fax: 1-866-902-4910
email: stacey@canadafirstmortgage.com

 
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