Personal Credit Application

Principal Information

Full Legal name: *

Phone: *

Email:

Date of Birth (month, day, year) : *

SIN number:

Married: *

Home Address: *

Postal code *

City:

Province:

Years at Address:

Ownership Details:

Own Home
Rent Home

Monthly Rent (If Rented):

Mortgage Payment (If Own):

Mortgage Balance (If Own):

Value of Home (If Own):

Employment Information

Employer:

Employer Address:

Income ($):

Occupation:

Years at Current Job:

Contact Person:

Phone:

Previous Employer (If less than 2 years):

Years At Previous Employer:

Gross Income ($):

Contact Person:

Other Income:

Vendor and Equipment Information

Dealer Name: *

Phone:

Email:

Sales Rep:

Equipment Cost:

Term Requested:

Serial Number:

Equipment Status:

New
Used

Make:

Model:

Km's:

Trailer Length:

LeaseLine Information

How Did You Find LeaseLine?

Additional Comments:

Agreement

I have read the terms & conditions above and agree. *

LeaseLine is a trade name of LeaseLine Financial Services Corp (herein “LeaseLine”). The undersigned certifies to LeaseLine that the above information, as well as any other information provided to LeaseLine or it’s agents from time to time, is true and correct and may be used in connection with this credit application and any subsequent finance arrangement. Moreover, the undersigned authorizes and consents to LeaseLine’s collection, use and disclosure of any such information in accordance with LeaseLine’s Privacy Policy which includes, but may not be limited to, requesting credit information from one or more credit reporting agencies and disclosing all such information, correspondence and communication contemplated herein to one or more lenders and/or financials institutions and their agents for the purpose of arranging financing. The undersigned further authorizes and consents to LeaseLine saving all information, correspondence and communication from its customers for ongoing auditing, compliance and marketing purposes. Authorization and consent provided by digital means, including our online application form or a digital signature as an example, will be deemed to have the same force and effect as written Authorization.