Company Information

Fields in red MUST be completed

Company Legal Name

Trade Name

Email

Address

City

Province

Postal Code

Contact Name

Title

Telephone

Fax

Industry

Years In Business

Type of Business

Landlord Name

Contact

Telephone

Fax

Bank Name

Branch

Contact

Account Number

Address

City

Telephone

Fax

Owner / Partner / Principal Information

Principal 1

First Name

Initial

Last Name

SIN

Date of Birth

Ownership

%

Address

City

Province

Postal Code

Telephone

Fax

Home

Value

Mortgage / Rent

$

$ / Month

Status

Dependents

Spouse Name

SIN

Date of Birth

Bank Name

Branch

Contact

Account Number

Address

City

Telephone

Fax

Credit Card Grantor

Credit Card Number

Expiry Date

Name on Credit Card

Owner / Partner / Principal Information

Principal 2

First Name

Initial

Last Name

SIN

Date of Birth

Ownership

%

Address

City

Province

Postal Code

Telephone

Fax

Home

Value

Mortgage / Rent

$

$ / Month

Status

Dependents

Spouse Name

SIN

Date of Birth

Bank Name

Branch

Contact

Account Number

Address

City

Telephone

Fax

Credit Card Grantor

Credit Card Number

Expiry Date

Name on Credit Card

Owner / Partner / Principal Information

Principal 3

First Name

Initial

Last Name

SIN

Date of Birth

Ownership

%

Address

City

Province

Postal Code

Telephone

Fax

Home

Value

Mortgage / Rent

$

$ / Month

Status

Dependents

Spouse Name

SIN

Date of Birth

Bank Name

Branch

Contact

Account Number

Address

City

Telephone

Fax

Credit Card Grantor

Credit Card Number

Expiry Date

Name on Credit Card

Lease Details

Vendor (If unknown put TBA)

Contact

Telephone

Fax

Equipment Description

Term

Equipment Cost ( Pre Tax )

Months

$

The undersigned certifies the above information to be true and correct. By signing and submitting this application, I/we hereby consent to and authorize Equirex Leasing Corporation and its related entities/corporations (“Equirex”) to verify, conduct, collect, use, and disclose where necessary, financial and credit investigations for the purposes of reviewing, considering, approving, administrating, maintaining and/or enforcing the leasing/financing sought herein, including obtaining any information required from any source whatsoever, and each source is hereby authorize to provide such information to Equirex.

I/we understand, acknowledge, accept and consent to my/our personal information, along with the relevant financial and credit investigations to which I/we have consented to Equirex gathering, being shared between Equirex and other parties Equirex deems relevant to the credit analysis and lease administration process, including but not limited to credit reporting agencies, credit exchanges, leasing brokers/intermediaries and credit grantors, and any other relevant parties/organizations for the purposes specified herein. I/we are aware of, and consent to, my/our personal information being transmitted between Canada and the United States of America for the purposes mentioned above, and I/we further understand, acknowledge and accept that my/our personal information, and the privacy protections afforded thereto, are therefore subject to the laws of both Canada and the United States of America.

If Equirex declines this application, it may periodically review it at any time to reconsider its decision or to offer me/us other products or services. I understand and consent to this application being held on file by Equirex for the above purposes, as well as for statistical analysis, until the end of the leasing relationship, or if no relationship then for a period of twelve months, after which Equirex, in keeping with its privacy policy, will destroy this document. If I wish a copy of the official privacy policy, I may request same from Equirex.

I consent to receive communications from the Lessor by email or other forms of electronic communications and understand that I can withdraw my consent to receipt of electronic messages at any time.
Yes, I consent

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Equirex Leasing Corp - 101-1465 North Service Rd E Oakville, ON Canada L6H 1A7
Phone: 1-877-378-4739 - (905) 844-4424 Fax: 1-866-404-4148 Email: leasing@equirex.com