A-QUICK MORTGAGE SERVICES LTD.

Email: Tel: Fax:

Address of Subject Property: Email address: Fax Number:

P.P/E.V. Marital Status Ref. by: Amt. Requested:

Applicant: Date of Birth MM/DD/YY S.I.N. Home Phone: Bus. Phone:

Co-Applicant: Date of Birth MM/DD/YY S.I.N. Home Phone: Bus. Phone:

Address: City: Postal Code: How long:

Previous Address (If less than 3 years at present address): Postal Code: How Long:

Applicant’s Present Employer & Address: How Long: Occupation: NET ANNUAL Income:
$

Applicant’s Previous Employer (If less than 3 years): How Long: Source of Other Income:

Co-Applicant’s Present Employer & Address: How Long: Occupation: NET ANNUAL INCOME:

Co-Applicant’s Previous Employer (If less than 3 years): How Long: Source of Other Income:

Bank & Branch Address: Account Number: Total Annual Income:

Financial Statement:
Assets: Value Liabilities: Monthly Balance
Cash in Bank $ Bank loan $ $
Real Estate – Residence $ Mortgage Lender $ $
Deposit on property $ $ $
Term Deposit/G.I.C.’s $ Loan / Lease Payment $ $
Auto (yr/make) $ $ $
Auto (yr/make) $ $
Stocks/Bonds/CSB’s $ Credit cards (please list) $ $
RRSP $ $ $

Total Assets $ $ $
Total Liabilities (subtract) $ $ $
Net Worth $ Total Liabilities $ $
Storeys: Sq. ft.: Basement SF: Garage TYPE: FP: LOT SIZE UFFI:

Full Bath: RENTAL INCOME MLS#: Age: Main. Fee $: ASSESED VALUE Taxes $:

Legal Description:

I/We hereby certify that the information we have given, to the best of our knowledge is correct and true. I/We consent to A-Quick Mortgage
Services and or its agents, obtaining reports containing credit and/or personal information as necessary in connection with this application.

Applicant Date Co-applicant Date

A-Quick Mortgage Services Inc.