Assets: (Cars, Rrsp, Savings, Rental Property Etc.)
|
Value
|
Liabilites: (Credit Cards, Loans,
Collections, Support) |
Balance
|
Monthly Payment
|
|
|
|
|
|
|
|
|
|
|
Are You Now Or Have You Ever Been
Bankrupt If Yes, When?
|
|
|
|
|
|
| References (Name, Address, Phone Number) |
|
Name:
|
Address
|
Phone Number:
|
Name:
|
Address
|
Phone Number:
|
Name:
|
Address
|
Phone Number:
|
|
I/We hereby certify that the information provided herein is truthful and accurate. I/We acknowledge that a consumer report containing credit iformation may or will be referred to in connection with this application. I agree that the financal source may give to, receive and share/exchange credit and other information about me with others including credit bureaus and other persons with whom I have or may have financial dealings, now and in the future. |
