Specializing in equipment leasing in the
Construction, Distribution, Food Processing,
Forestry, Manufacturing and Transportation
Industries

Industrial Credit is positioned to offer very
competitive pricing and flexible arrangements.

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Full Legal Name *
Home Address *
Home Phone *
Alternate Phone Number

Social Insurance Number

GST Number
Date of Birth
Marital Status
Spouse
No of Dependants
Present Employer
Contact Name
Employers Address
Position
How Long Employed
Gross Monthly Income
Full or Part Time
Assets Cash Value Liabilities Balance Owing
Cash Holdings : Credit Cards :
Real Estate : Mortgages :
Other Investments : Bank/Finance Loans :
RRSP Other Debts
Automobiles/Boats:
Other Assets- Describe :
Total Liabilities
Total Assets Total Liabilities + Personal Net Worth
Total Net Worth
Have You ever Declared Bankruptcy? Do you have Judgements against you?

DECLARATION
I, the applicant warrant and confirm that the information given herein is true and correct and that I understand that it is being used to determine my credit responsibility. Industrial Credit Corporation and ICC Mercado Financial Corporation hereinafter referred to ICC its agents or affiliates (collectively ICC) are authorized to obtain, and any source is authorized to disclose, any information ICC may require at any time relative to this application from each source to which ICC may apply and each such source is hereby authorized to provide ICC with such information. ICC is furthermore authorized to disclose in response to direct inquiries from any other lender or any Credit Bureau such information on my loan account as you consider appropriate and I agree to indemnify ICC against and save you harmless from any and all claims in damages or otherwise arising from such disclosure on your part. I acknowledge that I have been informed by ICC or its representatives that the personal information collected is collected, used and disclosed for the following purposes:
(a) understanding my needs and determining the suitability of particular products or services for customers, including creating and maintaining credit scoring models;
(b) determining my eligibility for products and services, including the identification of any guarantors; assessing applications and conducting initial and periodic credit checks
(c) Providing me with relevant products, service or information, including information about promotions or other opportunities by whatever means (including direct marketing)offered by ICC, its affiliates, and selected service providers in which customers or others may be interested;
(d) maintaining an on-going relationship with me;
(e) where circumstances require, collecting amounts outstanding from me and those have provided security for me;
(f) protecting against fraud or;
(g) meeting legal and regulatory requirements, including tax or other reporting requirements. I understand that ICC collection, use and disclosure of my personal information shall be done in accordance with its Privacy Policy and applicable law and hereby consent to such collection, use and disclosure. I specifically acknowledge that ICC may disclose my personal information regardless of when or how such information was collected, to related companies; its service providers; its agents, contractors, lawyers and external advisors; payment system operators; credit reporting agencies; rating agencies; other financial institutions and credit providers; government and other regulatory bodies; and any individuals or organizations that
(i) provide as references
(ii) who act on my behalf, or
(iii) who have been engaged to provide services to me. I further specifically acknowledge that ICC may assign this transaction in whole or in part from time to time and agree that any personal information collected may be made available to any such proposed assignee or the banker or funder or affiliate of ICC.
Applicant Acknowledges receipt of ICC’s Privacy Policy

Signature
Date

Company  |  Application-commercial  |  Application-personal  |  Why Lease  |  About Us  |  Privacy Policy  |  Contact Us

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