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Loan Application

Loan Information

Amount Requested: Purpose of Loan:
Applicant Personal Information
First Name: (required) Last Name: (required)
Contact Phone Number: E-Mail: (required)
Residence:
Address City
Province Postal Code
Income:
Type of Income: Total Annual Income:
Co - Applicant Personal Information
First Name: Last Name:
Income:
Type of Income: Total Annual Income:

Borrower's Declaration

In connection with my application for credit, I hereby take notice that the company funding this mortgage and its assignees may be procuring and may be referring to a consumer report respecting me, containing personal and/or credit information. I hereby consent thereto and to the disclosure of such information to other credit grantors in regards to my application for financing. I am in good health and able to perform my usual duties of my livelihood. I assume any risks associated with internet or electronic transmission. The statements herein are made for the purpose of obtaining this loan and are correct to the best of my knowledge.



Please note that this data is sent unencrypted and may possibly be intercepted by a third party. If you feel uncomfortable submitting this information online then please contact Judy for alternate means of application.

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Mortgage Agent Licence number M08001713 / Upper Canada Funding Inc Broker Licence 10165