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Applicant Information
First / Middle / Last Name: *
Date of Birth: *
Entity Type: *
Corporation
Partnership
Proprietorship
Other
Years in Business: *
Corporate / Partnership Name: *
Gross Yearly Revenue: *
Address: *
City: *
Postal Code: *
Province: *
AB
BC
MB
NB
NFLD
NS
NWT
ON
PEI
QC
SK
YK
Phone: *
Cell:
Fax:
Email: *
Acres Owned: *
Rented: *
Coordinates: *
Livestock Owned:
Type:
Crop Insurance: *
Yes
No
Agristability: *
Yes
No
Other / Employment Income (if applicable)
Employer:
Years in Industry:
Occupation / Industry:
Salary / Annual Income:
Equipment Lease Details
Supplier: *
Contact: *
Phone: *
Fax:
Email / Other:
Description: Make / Model / Year: *
New or Used?: *
New
Used
Equipment Value: *
Payment Frequency: *
Monthly
Quarterly
Semi-annual
Annual
Term: *
24
36
48
60
72
Residual: *
Other Details (hours, kms, etc.): *
Financial Reference
Bank Name: *
Branch: *
How Long: *
Contact: *
Phone and/or Email: *
* By checking this box, I consent to the obtaining, from any credit reporting agency grantor, such information as Calidon Equipment Leasing may require at any time in connection with the credit hereby applied for and consent to the disclosure at any time of any information concerning the undersigned to any credit reporting agency or to any credit grantor with whom the undersigned has financial relations.
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