Request for financing

FORM

INFORMATION ON THE CREDIT-LESSEE

Legal name

Address

City / Province

Postal code

Contact

Type of business

Telephone

Cellular

Fax

E-mail

Since

FINANCIAL INSTITUTION

Institution type
CommercialPersonal

Name

Adress

City / Province / Postal code

Telephone

Fax

Account number

Line of credit

Use

Attach the check specimen

SELLER INFORMATION

Name

Adress

City / Province

Postal code

Contact

Telephone

Fax

Prog. Number

SELLER INFORMATION

Amount

Description

Price

Attach the quote

MODALITÉS DE PAIEMENT

Equipment value

Deposit

Amount financed

Term (months)

Reprise

PERSONAL INFORMATION

Name

Adress

City / Province

Postal code

Home phone

Social insurance number

Date of Birth

Owner Y/N

Since

Value (real estate)

Mortgage balance

AUTHORIZATION: The lessee and / or the surety confirm that the above information is true. In addition, it authorizes Volvo Lac St-Jean, or any other financial institution to request and exchange any information in order to carry out a credit study.

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