CREDIT APPLICATION FORM

Just complete the Personal Information and Job Information on the form below to get started and you will receive a call for additional information. *A FULL APPLICATION will allow prompt processing of your account.

Applicant Information: Co-Applicant Information:
First Name: First Name:
Last Name: Last Name:
Date of Birth: Date of Birth:
SIN #: SIN #:
Employment: Employment:
Income: Income:
Rent or Own: Rent or Own:
How Long: How Long:
Address:
City:
Postal Code:
Home Phone:
Business Phone:
Best time to call:
Email Address:
Applying for:
Do you have any additional questions?

________________
DISCLAIMER: By submitting this form you agree to: I/We hereby authorize
Mortgage Financial Corporation/Steve Hencze hereinafter referred to as "the broker" to arrange on my/our behalf the loan described above and certify that the above information which is furnished with the intent that it be relied upon by the Broker to obtain said credit, is true and correct and 1: I am not in arrears on my present mortgage. 2: the above information includes all my/our debts and that we have no current unsatisfied judgments against us and that I/we have not declared bankruptcy in the last six years and that all my/our outstanding credit are current and in good standing. 3: I/we acknowledge that the Broker may also be receiving a finders fee in respect to the arranging of this loan, and I/we hereby waive any right to deny or dispute the Broker from receiving said finder fee. 4: In Connection with my application for credit, I/we hereby take notice that you may be procuring and may be referring to a consumer report respecting me/us containing personal information and I/we hereby consent thereto and to the disclosure of such information to other credit grantors or consumer reporting agencies and to retain this application for the Brokers records.

If you have further questions or need to speak with me please do not hesitate to contact me.

Thank you
Steve Hencze
”The Casual Guy”
Mortgage Agent Licence #M09002425
Phone (905) 529-2521 Toll Free: (866) 604-8860 Fax: (905) 525-9701 
Contact me at (519) 375-5924 or info@thecasualmortgageguy.com for more information.
Head office 12 Ray St S. Hamilton, ON L8P 3V2