Business: Proprietor Lease Application

  Thank you for considering Accurate Leasing for your leasing needs. Please supply the information requested below to help us determine the best leasing options for your particular needs. Fields marked with an asterisk should be filled out. All other fields are optional but will assist in speeding up the lease process. The information you provide is confidential and is used for the sole purpose of pre-approving your lease application. Call us at (800) 595-1477 if you need help filling in this application.
* Operating Name: Business Address:
City: Province:
Postal Code: * Phone:
Fax: Cell No.:
E-Mail Address: Website Address:
Landlord/Mortgagee: Type of Business:
No. of Employees: Years in Business:
Annual Gross Revenue/Sales:  

Business Banking
Business Bank Name: Branch:
Phone: Contact:
Business Bank Account No.: Years with Bank:

Trade Reference (Name): Phone:
Trade Reference (Name): Phone:

Business Owner
* Last Name: * First Name and Initial:
Birthdate (ie. MM/DD/YY): Social Insurance Number:
Spouse's Last Name: First Name:
Birthdate: Social Insurance Number:

Owner's Home Address
Address: City:
Province: Postal Code:
* Phone: Housing Status:
Monthly Housing Payments: Years at Address:

Previous Address (if less than 3 years at current address)
Address: City:

Personal Income
Gross Monthly Income: Other Occupation (if applicable):
Secondary Monthly Income:  

Previous Employer (if less than 3 years at current job)
Name: Occupation:
Years at this Job:  

Employer's Name: Employer's Phone:
Occupation: Years at this Job:
Gross Monthly Income:  

Personal Banking
Your Personal Bank Name: Branch:
Phone: Bank Account No.:
Years with Bank:  

Equipment Supplier for the Lease
Supplier Name (if available): Supplier Representative:
Phone: Fax:
E-Mail Address:  
Description of Equip. to be Leased:
Equipment Cost (pre tax): Term Requested (months):

Please Add Your Comments:

Application Authorization and Consent

I hereby represent all information is true, correct and complete. Applicant agrees that the actof inserting your name in the space below constitutes your valid electronic signature and evidencesyour agreement with the same effect as your ink-signed signature. Furthermore the Applicantconfirms that the information provided in respect to this application is TRUE and COMPLETE andauthorizes Accurate Leasing Ltd. to reply and use this information in order to confirm youridentity and evaluate your credit worthiness in relation to the financing contract being enteredinto. In particular, you agree that Accurate Leasing Ltd. and its Affiliates and any thirdparties acting on behalf of Accurate Leasing Ltd. may obtain a credit bureau or other creditinformation from any credit reporting agency, credit bureau or credit grantor, and may hold,use, exchange and disclose such information for the purposes identified above. If theapplication is approved, the undersigned authorizes Accurate Leasing Ltd. to collect, hold, use,exchange and disclose your personal information as required, in order to administer your contract,determine your insurance eligibility and secure the asset being financed or as required orpermitted by. You also authorize Accurate Leasing Ltd. to use your personal information forinternal statistical analysis purposes. We will keep a file containing some or all of yourpersonal information at 814-1661 Portage Ave. Winnipeg, MB R3J 3T7 from time to time. Youhave a general right to access and rectify the personal information in this file by making awritten request to the above address attention: Privacy Officer.

Applicant 1:

Applicant 2:
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Partnership Lease      Proprietor Lease
Incorporated Lease      Personal Lease

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