Please Note;   If you experience any technical difficulties in submitting  this form 
or wish to talk directly to a program specialist, please call 416-367-8370.
Credit

Personal Information
Note: No credit inquiries will be initiated until we have contacted you personally. All information is private and confidential and remains secure within our system.
Reason for Loan:
 
Owner's First Name

M

Last Name

x

Co-Owner's First 

M

Last Name

x

Address

City

x

Home Phone

Cell

 x

E-Mail Address
i
i
x

Province

 Postal Code Yrs at Present Address

Yrs.
x

Previous Address

City

m
Repairs/Renovations
Required
Interior m Exterior
i Basement Finishing
Kitchen
Bathroom
Flooring
Windows
Interior Painting
i Concrete Work
Roofing 
Exterior Painting
Driveway
Interlocking Stone
Brickwork

Other Type of Work

Mainly Interested in Financing
x

How did you hear about us?
Talk 640 AM (Mojo Radio) The Jewel-88.5 F.M.
CFRB AM Private Referral
Billboard TV Ad
Internet Local Paper
Flyer Home Advantage Club

Name of Referral Source
(not required)

Note: No action will be taken until we have contacted you personally.
Personal

Personal Information
Note: No credit inquiries will be initiated until we have contacted you personally. All
information is private and confidential and remains secure within our system.
ui
Owner m Co-Owner

Date of Birth

S.I.N. #

Day

Yr.

x

Employer's Name

Phone
i
z

Occupation

 Gross Annual Income

x
How Long at this job? i yrs.
x

2nd Employer Name

 x

Annual Income

Date of Birth

S.I.N.#
Day Yr:
x

Employer's Name

 Phone
i
z

Occupation

Gross Annual Income

x
How Long at this job? i yrs.
x

2nd Employer Name

 x

Annual Income

ssets

Assets
Type of Home # of 
Bedrooms		 Year 
Purchased

RRSP's?

Approx. Value

Other Assets

Value

Primary Bank

Location (or other name)

Purchase Price Annual Taxes Present Value

2nd 
Property Type

 Year 
Purchased 

Purchase Price

 Annual Taxes

Present 
Value

liabilities

Liabilities
Mortgage Lender Other Bank Branch
Interest Rate Renewal Year Monthly Payment Balance Owing
%
Is there a 2nd Mortgage? If Yes, specify amount: Payment Lender:
per mo.
Credit Card Credit Card
Balance Owing Balance Owing
Outstanding Loans (Lender) Balance Monthly Payment
Car Loan/Lease Type of Car Model Year Balance Mo. Payment
Type of Car Model Year Balance Mo. Payment
Other
How would you rate your own credit history?

If you are requesting debt consolidation, 
what is the amount you are seeking?

$

Please help us avoid "Telephone Tag."  The best times to call are:

Best Day(s)

 Best Time(s)

Note:

You are not obligated to borrow any funds that may be offered to you as a result of this process.

Submitting this form does not automatically initiate a credit inquiry. You are simply registering into The Renovation Funding Program .You will be contacted personally before any such inquiries are initiated.

Comments:

If you are not contacted within 48 hours,
please call us immediately at 416-367-8370
Note: if you have any problems submitting this form, or if you wish to register directly with one of our credit specialists, please call us at 416-367-8370.