Canadian Commercial Loan Application

Applicant Information

Name*

First Last

Address*

Street Address Address Line 2 City Province Postal Code

How long at current address*

Own or Rent Home*

Previous Address*

Street Address Address Line 2 City Province Postal Code

Home Phone*

Cell Phone

Email*

Social Insurance Number*

Date of Birth*

MM

DD

YYYY

Drivers License*

Canadian Resident?

Yes
No

Are you under bankruptcy protection?

Yes
No

Employment Information

Self Employed?*

Yes
No

Owner/Operator?

Yes
No

Employer (or Contracted to) Name*

Employer (or Contracted to) Address *

Street Address Address Line 2 City Province Postal Code

Employer or Business Phone

Length of time with Employer

Employer Contact Name

Phone Number

If you own a Company what is the name?

How long in business?

Business Phone Number

Name(s) of Directors

Personal References

Personal Reference 1*

Phone Number*

Personal Reference 2

Phone Number

Vehicle Information

Year*

Make*

Model*

Vehicle ID Number (VIN)*

All 17 characters of the VIN are required.

Mileage in Kilometres*

Vehicle Owned or Leased*

Owned
Leased

Name of Lessor*

Owner or Lease holder

Dealer Name*

Dealer Phone

Dealer Contact Name*

Estimate of Repair Cost*

Reason for repair*

e.g. I need to repair my engine and transmission. Want to get remanufactured parts for the repair.

Tax Information

Are you current with your remittances to the Canada Revenue Agency (CRA) for:

Personal Taxes*

Current
Not Current

Corporate/Business Taxes*

Current
Not Current

Employee Source Remittances (if applicable)?*

Current
Not Current

If not applicable, select "Current"

GST/HST Filings*

Current
Not Current

If requested, are you willing to provide copies of your notice of assessments (NOA) to support the above remittances?*

Yes
No

Documentation

To accompany loan application for Initial Approval:

Completed Loan Application
Copy of Vehicle Ownership
Proof of Insurance (Copy of Certificate)
Copy of Debtor’s Driver’s License
Copy of Dealer estimate or quote

Information to follow for Final Approval:

Copy of Lease Agreement (if applicable)
Copy of Articles of Incorporation and/or Business Registration (if applicable)
Copy of Broker Agreement or Transportation Authorities (if applicable)
2nd Piece of identification i.e. Citizenship, Birth Certificate, Passport or Social Insurance Number (SIN)
Proof of wage/income and Financial or Bank Statements
Void Cheque (for pre-authorized payments)
Copy of Final Dealer invoice signed by owner

Select files from your computer

Drop files here or

Optional

How did you hear about EZ Repair Loan?

Consent*

I acknowledge and consent to collection of my personal credit information.

Are you human?

Please enter the text within the image.

Instructions

After completing fields, please click Submit Application Now button to send your information to EZ Repair Loan.

Important: You will receive a copy of your application to the provided email address. If you do NOT receive that email within 30 minutes please call us at 905-212-9912 or Toll-free: 1-844-212-9912.