Equipment Details & Vendor Information

Vendor
Terms Requested (years or months)
Location
Equipment Description
Phone Number
Price
FCL Rep
New or Used?
New     Used

Applicant's Personal Information

Applicant's Name (Full Legal Name)
No. of Dependants
Birth Date (M/D/Y)
S.I.N.
Spouse's Name (Full Legal Name)
Birth Date (M/D/Y)
S.I.N.
Home Phone Number
Fax Number
Cell Number
Email Address
Current Address
City
Province
Postal Code
How Long
Property Status
Former Address (if less than 2 years)
City
Province
Postal Code
How Long
Property Status

General Corporate Information

Full Legal Business Name
Contact
Phone
Fax
Address
City
Province
Postal Code
Type of Entity
Years In Business
# of Employees
Shareholders & Ownership %
Type of Business

Financial and Lending Information

Name of Lead Bank
Branch Location (Branch #)
Phone Number
Nature of Dealings
Name of Lending Instituion
Branch Location (Branch #)
Phone Number
Nature of Dealings
Mortgage Holder
Phone Number
Monthly Mortgage Payment
Any previous dealings with FCL?
Yes     No
Any prior repossessions?
Yes     No
Any legal suits?
Yes     No
Have you ever declared bankruptcy?
Yes     No
If YES to any of the above, please explain below.

Personal Net Worth

Assets
Value
Liabilities
Monthly Payment
Balance Owing
Residence
$
Mortgage
$
$
Other Real Estate
$
$
$
Cash On hand
$
Loans
$
$
Personal Vehicles
$
$
$
Investments & RRSP's
$
Credit Cards
$
$
Total Assets
$
Total Liabilities
$
$
(Total Assets - Total Liabilities) NET WORTH =
$
The undersigned consents to First Capital Leasing Ltd.'s (FCL) collection, use, and disclosure to its affiliates, credit bureaus, reporting agencies, financial institutions, and businesses with whom each of the undersigned has had financial relationships and other references provided in support of this application (and disclosure by these parties to FCL), of the information provided herein and credit and financial information obtained from the above sources for the purposes of obtaining and using a credit information report and verifying current and ongoing creditworthiness of each of the undersigned and other information provided in connection with this application. FCL may disclose credit and financial information connected with this application to future creditors and lenders that request credit references. SIN's (optional) and other personal identifiers will be used solely for matching of credit bureau/reporting agency information and/or verifying the identity of the undersigned. The undersigned consents to the collection, use, and disclosure of personal information by FCL and the persons referred to in the related lease, finance or rental agreement for the above purposes and the purposes described in the related lease, finance or rental agreement.