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    Jeff DillonMitch ThibodeauI don't have an agent

    Personal Information

    First Name
    Last Name
    Email
    Address
    How Long?
    City
    Postal Code
    Res #
    Bus #
    Cell #
    Previous Address (if less than 3 years as current)
    City
    How Long?
    S.I.N.
    Date of Birth (mm/dd/yy)
    Current Employer
    How Long?
    Business Address
    Business Telephone
    Current Position
    Are you...
    SalaryHourlyCommissionSelf Employed
    If hourly, what is your hourly rate and number of guaranteed hours per week?
    If Salary, what is your income?
    Are you Full-time or Part-time
    Previous Employer (If less than 3 years as current)
    Business Address



    Co-Applicant Information

    First Name
    Last Name
    Email
    Address
    How Long?
    City
    Postal Code
    Res #
    Bus #
    Cell #
    Previous Address (if less than 3 years as current)
    City
    How Long?
    S.I.N.
    Date of Birth (mm/dd/yy)
    Current Employer
    How Long?
    Business Address
    Business Telephone
    Current Position
    Are you...
    SalaryHourlyCommissionSelf Employed
    If hourly, what is your hourly rate and number of guaranteed hours per week?
    If Salary, what is your income?
    Are you Full-time or Part-time
    Previous Employer (If less than 3 years as current)
    Business Address



    Income

    What did you each earn in gross income last year?

    Applicant Co-Applicant

    What will you each earn in gross income this year?

    Applicant Co-Applicant

    Note: If commissioned or self employed, we average your last two years of earnings. Please forward copies of

    your last two years Notice of Assessments from Revenue Canada.



    Banking Information

    Bank Name Branch Location Types of Accounts
    ChequingSavings
    ChequingSavings



    List of Assets and Approximate Value

    Cash RSPs
    Stocks Bonds
    GICs House
    Cottage Boat(s)

    Cars

    Year Make Model

    Any other assets not classified above? Such as a Gift to come from a relative?

    Do you own your home? If yes, when was it purchased and for how much?

    Please comment here as to what you intend to use for your down payment and how much. (If this is a house purchase)

    What Amount

    Address of house to be purchased. (If a purchase)

    Do you have a Real Estate Listing for this house? (If a new purchase)
    YesNo

    If yes, please forward a copy to this office



    Liabilities

    List approximate balance, payment amount, and name of company.

    Credit Cards

    Institution Payment Amount Balance

    Loans

    Institution Payment Amount Balance

    Leases

    Institution Payment Amount Balance

    How much is your current rent?



    Existing Mortgages

    (Please note if you have more than one Mortgage, please attach a list with the property address and Mortgage information below)

    Company Name Outstanding Amount
    Interest Rate Property Tax Amounts
    Current Payments Maturity Date

    By submitting this Electronic Application, I/we declare the above information to be a true and accurate representation of our financial position. I/we authorize Blackburn Financial Services Inc. operating as The Mortgage Professionals to obtain a Credit Report through Equifax Canada and I/we authorize you to exchange credit information and other information as required for the purpose of securing a Mortgage Commitment. Blackburn Financial Services Inc. is a registered Mortgage Broker (1954) through the Ontario Ministry of Financial Institutions.

    Any additional comments or questions you may have please provide below: