Online Application for Financing

Please fill out the form below. If you have any questions or concerns, please feel free to contact us for further information.

Legal Business Name:

Operating as (if applicable):

Year End:

Years in business:

Mailing Address:

City/Town:

Province:

Postal Code:

Phone:

Cell:

Fax:

Email Address:

Principle Name(s):

Bank:

A/R:

Industry:

Annual Revenue:

Commercial Assets

Asset Name:

Approx. Value:

Approx. Balance:

Financed With:

Asset Name:

Approx. Value:

Approx. Balance:

Financed With:

Asset Name:

Approx. Value:

Approx. Balance:

Financed With:

Personal Statement

My personal address is the same as the commercial one.

Applicant's Name:

S.I.N.#:

Date of Birth (m/d/y):

Home Address:

City / Town:

Province:

Postal Code:

Phone:

Cell Phone:

# of Years:

Monthly Payment:

Previous Address:

City:

Province:

Spouse's Name (if applicable):

Personal Assets

	Approx. Value
Home:
Other Real Estate:
Vehicle(s) (Total):
Cash:
RRSP's:
Stocks, Bonds, Investments:
Other:

Personal Liabilities

	Approx. Value
Mortgage:
Other Mortgage:
Vehicle(s) Loan/Lease (total):
Line of Credit:
Other:

Enter the name of the vendor or seller, or indicate if 'To be determined':

PRIVACY: WE THE UNDERSIGNED HEREBY AUTHORIZE Yellowhead Equipment Finance Ltd.., INCLUDING ANY PROPOSED ASSIGNEE (HEREINAFTER REFERRED TO AS “YOU”, AND YOUR”) OF ANY FINANCING TRANSACTION BETWEEN US AND YOU IN CONNECTION WITH THIS CREDIT APPLICATION, TO COLLECT, USE, AND DISCLOSE CERTAIN PERSONAL AND BUSINESS INFORMATION FROM AND ABOUT US (“INFORMATION”). YOU MAY COLLECT INFORMATION FROM AND/OR DISCLOSE INFORMATION TO YOUR AGENTS, AFFILIATES, THIRD PARTY SERVICE PROVIDERS, CREDIT BUREAUS, CREDIT REPORTING AGENCIES, OTHER CREDIT GRANTORS, FINANCING PARTNERS, AND/OR ANY PERSON WE HAVE OR PROPOSE TO HAVE FINANCIAL RELATIONS WITH AS WELL AS THIRD PARTIES WHO WISH TO BECOME INVOLVED IN THE SYNDICATION OF A LOAN, LEASE, OR OTHER INVESTMENT IN WHICH INFORMATION IS RELEVANT, OR WHO ARE INVOLVED IN RISK ASSESSMENT OR DUE DILIGENCE IN THE CONTEXT OF A FINANCIAL TRANSACTION OR PROPOSED FINANCIAL TRANSACTION. WE ALSO AUTHORIZE ANY PERSON WHOM YOU MAY CONTACT IN THIS REGARD TO PROVIDE INFORMATION TO YOU. WE ACKNOWLEDGE THAT YOU OR YOUR FINANCING PARTNERS MAY TRANSFER AND STORE INFORMATION TO JURISDICTIONS WHERE YOU OR YOUR FINANCING PARTNERS DO BUSINESS. AS A RESULT, INFORMATION MAY BE ACCESSIBLE TO REGULATORY AUTHORITIES IN ACCORDANCE WITH THE LAWS OF THESE JURISDICTIONS. YOU AS WELL AS YOUR FINANCING PARTNERS AND OTHER PARTIES INVOLVED MAY COLLECT, USE, AND DISCLOSE OUR SOCIAL INSURANCE NUMBERS OR OTHER PERSONAL IDENTIFIERS TO VERIFY AND REPORT CREDIT INFORMATION TO CREDIT BUREAUS OR CREDIT REPORTING AGENCIES AS WELL AS TO CONFIRM OUR IDENTITIES AND COMPLY WITH REGULATORY REQUIREMENTS. YOU AS WELL AS YOUR FINANCING PARTNERS AND OTHER PERSONS INVOLVED MAY OBTAIN CREDIT REPORTS FROM CREDIT REPORTING AGENCIES SUCH AS, WITHOUT LIMITATION, EQUIFAX CANADA INC., BOX 190 STATION JEAN TALON, MONTREAL, QUEBEC H1S 2Z2, WITH TELEPHONE 1-800-465-7166. YOU MAY GIVE INFORMATION ABOUT US TO YOUR FINANCING PARTNERS AND OTHER PERSONS INVOLVED SO THAT THEY MAY TELL US DIRECTLY ABOUT THEIR PRODUCTS AND SERVICES. WE UNDERSTAND THAT YOU AS WELL AS YOUR FINANCING PARTNERS AND OTHER PERSONS INVOLVED WILL KEEP A FILE CONTAINING SOME OR ALL OF OUR INFORMATION WHETHER OR NOT A FINANCIAL TRANSACTION IS COMPLETED. WE UNDERSTAND THAT WE HAVE A GENERAL RIGHT TO ACCESS AND RECTIFY THE INFORMATION IN THIS FILE BY MAKING A WRITTEN REQUEST TO YOU AT THE FOLLOWING ADDRESS: 409, 1 Tache Street, St. Albert, AB T8N 1B4. WE UNDERSTAND THAT OUR CONSENT TO THIS IS NOT A CONDITION OF DOING BUSINESS WITH YOU AND WE MAY WITHDRAW IT AT ANY TIME. BY CHOOSING TO PROVIDE YOU WITH INFORMATION, WE ARE CONSENTING TO ITS USE IN ACCORDANCE WITH PIPEDA, THE PERSONAL INFORMATION PROTECTION AND ELECTRONIC DOCUMENTS ACT AT HTTPS://WWW.PRIV.GC.CA/EN/PRIVACY‐TOPICS/PRIVACY-LAWS-IN-CANADA/THE-PERSONAL-INFORMATION-PROTECTION-AND-ELECTRONIC-DOCUMENTS-ACT-PIPEDA/ OR APPLICABLE PROVINCIAL LAW OR ACT.

Type your name in the field below in order to accept conditions:
Please answer below: 0 + 7 =

indicates required field.