Name of Business: Bus Tel:
Address: Bus Fax:
City: Province: Postal Code:
Corporation Partnership Proprietorship
Contact Name: Email address: Years in Business:
First Name: Middle: Last:
Home Tel: Cell Phone:
Address: City: Prov: Postal Code:
Date of Birth:mm / dd /yy SIN # ‐ ‐ % Shares Owned:
Personal Residence: Own Rent Mortgage/Rent Pmt: $
Have you filed for bankruptcy in the last 10 years ? Yes No
Do you have any judgements, child support, student loans or collection agency to report ? Yes No
PERSONAL NET WORTH STATEMENT
Assets (What you own) What you own in Dollars Liabilities (What you owe) Amount Owing in Dollars
Cash in Savings Account Mortgage
Home – Real Estate Mortgage – 2nd property
Other Real Estate Credit cards
Equity in business Other loans
TOTAL ASSETS Net Worth (Assets – Liabilities)
DEALER NAME AND EQUIPMENT DETAILS
Dealer Name: Contact Name:
Address: City: Province: Postal Code:
Tel: Fax: Email:
Year Make Model Selling Price (Before Tax)
I/We certify the above information to be true and correct. I/We hereby authorizes Commercial Leasing Group Inc., and / or any of its designated underwriters, or an authorized Equifax Agent, to obtain, or
exchange personal information in whatever manner it may deem satisfactory, all the credit information it requires, whatever the source, such source(s) being hereby authorized to provide such information.
CONSENT TO PERSONAL INFORMATION SHARING. Lessee consents and authorizes Lessor and its agents, at any time to communicate with and disclose to third parties (including Credit Reporting Agencies, Credit
Exchanges, Leasing Brokers and Credit Grantors) any of Lessee credit, financial and personal information that Lessor deems necessary to complete, service or enforce this Lease and Ancillary Agreements, including
additions, modifications, updates or other related transactions, including but not limited to the Assignment, Sale or Securitization of this Lease. This clause survives the term or termination of this Lease.
CREDIT INVESTIGATION. Lessee hereby authorizes Lessor to conduct financial and credit investigations of Lessee for the purposes of approval, maintenance and enforcement of this Lease, or any judgement
obtained by Lessor as a result of any default hereunder, and to obtain any information required from any source to which it may apply, and each source is hereby authorized to provide such information to Lessor.
This includes, but is not limited to, the Lessor obtaining information from any credit reporting agency, creditor of Lessee, or banking and other financial institution where Lessee may have credit or depository
facilities. Lessor may obtain such information at any time before or during the Lease Term or after termination of the Lease in the event any monies remain owing to Lessor.
WAIVER. The parties hereto agree that this Agreement and all documents related thereto be written in the English language. (Les parties en présences conveniennent à ce que ce document soit rédige en anglais.)
I/We have read and understand and agree with the above terms and conditions.
Applicant Signature Print Name Date .
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