You
are now using a secure web server for this transaction.
Please fill out this application and submit it to me 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 .
Previous Employment(if current employer is under 3 years)
Previous Employer
Previous Employer
Occupation
Occupation
Length
of Time
Length
of Time
Annual Income
Annual Income
»
Liabilities
Total
outstanding
balances:
Credit
Cards
$
Loans/
Lines of
Credit
$
Total monthlypayments:
Car
Payments
$
Alimony/
Support/
Other
$
» Existing Home(s) (if applicable)
Address w/ postal code
Purchase Date
Style
Garage Size
Square Footage
Ownership
Approximate Value Today
Age
Garage Type
» Existing Mortgage
Lender
Mortgage Amount
$
Rate
Value of Home
$
Term
Date of Purchase
Maturity Date of Mortgage
Payments Per Month
»
Assets
Vehicle
1 (Year, Make,
Model)
RRSPs
$
Vehicle
2 (Year, Make,
Model)
Stocks/
Bonds
$
Name of
your bank(s)
Cash/
Savings
$
»
Other
Downpayment Amount
$
Where is the downpayment derived from?
How did you hear about us?
Name
Phone
Email
»
Comments / Notes
When refinancing existing
mortgages, or applying for a second mortgage, please add
any helpful notes, such as address of property and brief
description. Please indicate debts to be paid off from
new mortgage. If buying, will you be selling your
existing home if buying new? What is your estimated sale
date?
CONSENT FORM
PLEASE READ BEFORE SUBMITTING APPLICATION
I/we warrant and confirm that the information in the mortgage application form is true and correct and I/we
understand that it is being used to determine my/our credit responsibility and to evaluate and respond to
my/our request for mortgage financing. You are authorized to obtain any information you may require for these
purposes from other sources (including, for example, credit bureaux) and each source is hereby authorized to
provide you with such information. I/we also understand, acknowledge, and agree that the information given in
the mortgage application form, as well as other information you obtain in relation to my credit history, may be
disclosed to potential mortgage lenders, mortgage insurers, other service providers, organizations providing
technological or other support services required in relation to this application and any other parties with whom
I/we propose to have a financial relationship.
I/we further acknowledge and agree that each potential mortgage lender, mortgage insurer or service provider
to whom you provide the mortgage application and/or my/our personal information is permitted to receive such
application and information and maintain records relating to me/us and my/our mortgage application and to
hold, use, communicate and disclose personal information about me/us, including my/our Social Insurance
Number (SIN) if I/we provide it , and collect personal information from me/us, you and from third persons,
including credit bureaux, credit reporting and collection agencies, financial institutions, my/our past and present
employers, creditors and tenants, my/our spouse or any other person who has information about me/us for the
purposes of recording, evaluating and responding to my/our application for mortgage financing or related
activities and I/we specifically consent to the release and disclosure of personal information by such persons to
and among you and each potential mortgage lender, mortgage insurer or other service provider.
