Ambassador

Financial Application Form

Thank you for your application! We will review your information and contact you within 24 hours.

Please correct the errors in the form before submitting.

Personal Information

First name *

Last name *

Social Insurance Number *

Gender *

Email address *

Date of birth *

Address

Address line 1 *

Address line 2

City *

Postal code *

Province *

Phone number *

Second phone number

Income Source

Income source *

Salary and other income

Please add all your sources of income. If your income does not come from employment, you may set your income hourly rate and weekly hours to 0.

Income hourly rate *

Income weekly hours *

Expenses

Please add all your monthly expenses. Note that your monthly obligation must be what you pay and not the payment as a whole. (For example: If you split the rent 50/50, you should only enter half the amount of the total rent.)

Monthly mortgage/rent *

Monthly car payments *

Monthly Electricity bill payments *

Monthly Micro Loan Payments *

Loan information

Amount *

Payment Frequency

Bank *

By submitting this form, I consent to the collection, use and disclosure of my personal information as described in the following paragraph. We are proud to apply policies and procedures to protect the personal information we collect and retain for our clients. Access to personal information is limited under the provisions of the Personal Information Protection and Electronic Documents Act (PIPEDA). By submitting your request, you accept that CONSULTANTS SUCCESS INC and other credit service associated with CONSULTANTS SUCCESS INC. will collect information from a credit agency to analyze your files.. *

Ambassador

Personal Information

Address

Income Source

Employer's Information

Pay frequency

Salary and other income

Expenses

Loan information

Nom(s) de l'entreprise

Profil du commerçant

Renseignements sur le propriètaire

Propriètaire, responsable ou associé #2