Applicant Information

First Name	MI	Last Name	Date of Birth	S.I.N.	Marital Status
					Single Married Separated Divorced Common Law

Current Address	City	Province	Postal Code	How Long?

Previous Address (if less then 3 Years)	City	Province	Postal Code	How Long?

Email Address	Home Phone	Work Phone	Cell Phone	Residential Status
				Rent Own Live with Parents Live with Others

Current Employer	Occupation / Title	How Long?	Pay Type (Select One)
			Salaried, Full Time Self Employed Hourly, Full Time Hourly, Part Time Other

Address	Annual Income

Number of dependents	Referred By	Referred by Other
	Select Individual T.J. Burnett Benny Woligroski Bill North Brian Bernacki David Nedokus Debra Black Donny Watson Equip #2 Sprint Car Frank Versace Gerald Bernard Harold Jeske Janice Burnett Jeremy Knight Justin Hintz Mark Yeryk Michael Froese Monica Kessler Paul Peters Paula Carlson Pierre Prest Prince Wiafe Reckseidler Team Rosalie Rattai Sheri Rehill Todd Labelle Terry Christianson Vivian Saulog Other

Co-Applicant Information (Complete if you are married or have a co-applicant)

First Name	MI	Last Name	Date of Birth	S.I.N.	Marital Status
					Single Married Separated Divorced Common Law

Current Address	City	Province	Postal Code	How Long?

Previous Address (if less then 3 Years)	City	Province	Postal Code	How Long?

Email Address	Home Phone	Work Phone	Cell Phone	Residential Status
				Rent Own Live with Parents Live with Others

Current Employer	Occupation / Title	How Long?	Pay Type (Select One)
			Salaried, Full Time Self Employed Hourly, Full Time Hourly, Part Time Other

Address	Annual Income

Number of dependents

Current Mortgage Information

Mortgage Holder	Current Value of Property	Current Mortgage Amount
Mortgage Interest Rate	Current Monthly Payment	Property Taxes

Details of Mortgage Loan

Mortgage Purpose:

Pre-Q Purchase Renewal/Transfer Refinance

Mortgage Amount:

Amortization:

35 yrs 30 yrs 25 yrs Other

If pre-qualifying, please fill in the following:

What is the purchase price of the home (or max. purchase price you wish to pay)?
How much down payment do you have?
Where is you down payment coming from?	Savings RRSP Line of Credit Sale of an Existing Property Gift Other
Closing Date (or date of planned purchase)

Liabilities: Please list all outstanding debts, including credit cards, loans, mortgage, car payments, alimony, etc.

Creditor / Description	Amount Owed	Monthly Payment

Assets: Please list all your assets, including homes, vehicles, RRSP's, Stocks, Bonds, Cash in Bank, etc.

Description	Value

Other Comments/Information: Please provide any additional information which could help us approve you.

Are you presently a co-signor on any loan?		Yes		No
Have you previously declared bankruptcy?		Yes		No

If yes, please explain.

By submitting this secure online application, I/we hereby authorize Equip Mortgage and Financial and all affiliated partners to obtain a credit report and make any necessary inquiries regarding my/our mortgage application and to release any of this information to any lender who may be interested in providing funds on my behalf.