Date:
Equipment:
Supplier:
Phone No.:
Sales Rep:
Cost:
Term:
Payment:
Additional Information:
Full Legal Name:
Phone Number:
Email Address:
Operating Name:
Contact:
Ltd. or Inc.?: Ltd Inc
Incorporation Date:
In Business Under Current Ownership Since:
Type of Business:
Number of Employees:
Address:
City:
Province:
Postal Code:
Full Name:
Social Insurance No.:
Date of Birth:
Home Address:
Home Phone:
Own Rent How Long?:
Market Value:
Mortgage Balance:
Bank:
Branch:
How Long?:
Account No.:
The undersigned consents to Atticus Financial Inc. (“Atticus”) ‘s collection, use and disclosure to its affiliates, its applicable service providers, credit bureaus, reporting agencies, financial institutions, and businesses with whom each of the undersigned has had financial relationships and other references provided in support of this application (and disclosure by these parties to Atticus), of the information provided herein and credit and financial information obtained from the above sources for the purposes of obtaining and using a credit information report and verifying current and ongoing creditworthiness of each of the undersigned and other information provided in connection with this application and for related administrative purposes. Atticus may disclose credit and financial information connected with this application to future creditors and lenders that request credit references. SIN’s (if provided) and other personal identifiers will be used solely for matching of credit bureau/reporting agency information and/or verifying the identity of the undersigned. Applicable service providers may be located outside of Canada, and the undersigned acknowledges that personal information may be processed and stored in foreign jurisdictions and that the governments, courts or law enforcement or regulatory agencies in those jurisdictions may be able to obtain disclosure of that personal information through the laws of the foreign jurisdiction. The undersigned consents to the collection, use and disclosure of personal information by Atticus, the third parties described above, and the persons referred to in the related lease, finance or rental agreement for the above purposes and the purposes described in the related lease, finance or rental agreement. The undersigned consents to the retention of personal information for a period of seven (7) years from the completion of any financing agreement that materializes from this application.
I, have read and understand the above and do hereby consent as required, on this
