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Personal Information

To complete the mortgage approval process, you will need to complete this application. Once you submit the application, we will be able to finalize your mortgage.

PRIVACY PROTECTION:
We take confidentiality very seriously! Your info will NOT be given out or used for promotional purposes other than to secure the service required.

Applicant Information

First name

Last name

Date of birth

S.I.N.

Marital status

Dependents

Current street address

City

Prov.

Postal code

Years there

Previous address (if < 3 yrs at current employer)

City

Prov.

Years there

E-mail address

Home phone
--

Residential status

Current employer

Current occupation

Work phone
-- x

Type of income

Current employer address

Gross yearly income

Years there

Co-Applicant Information

First name

Last name

Date of birth

S.I.N.

Relation to co-applicant

Current employer

Current occupation

Phone number
-- x

Type of income

Current employer address (please leave blank if you do not know)

Gross yearly income

Years there

Assets

Liabilities

Asset Type (Eg. Car, Savings)	Value
	$
	$
	$
	$
	$
	$
	$
	$
	$
	$

Type (e.g. Car Loan, Credit Card)	Balance	Monthly Payment
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$

Your Existing Mortgage

Details of First Mortgage (Complete this section only if you have an existing mortgage)

Mortgage held with (bank name)

Balance

Rate %

Payment

Schedule

Maturity date

Property address

Details of Second Mortgage (This could also be a first mortgage on a 2nd property)

Mortgage held with (bank name)

Balance

Rate %

Payment

Schedule

Maturity date

Property address

Desired Mortgage

Purchase price

Desired term

Amortization

Mortgage amount needed

Yearly property taxes (Approximate)

Desired Bank

Purchase Date (Approximate)

Type of Mortgage

Group Information

Select the group or charity that we can make a contribution to on your behalf).

Comments (Please provide any additional information which could help us with your request)

APPLICATION AGREEMENT

By selecting the "I Agree" box below, I/We (hereinafter collectively "I", "my", "me", etc.) hereby authorize Buyingblock.com (hereinafter "the Broker") to arrange on my behalf the loan described above (hereinafter the "Loan"). I certify that the above information, which is furnished with the intent that it be relied upon by the Broker to arrange the Loan, is true and correct.

In Connection with my application for the Loan, I acknowledge that you may obtain and rely on a consumer report containing personal information about me, and I consent thereto and to the disclosure of such information to other credit grantors or consumer reporting agencies, and to the Broker's retention of this application for the Broker's records.

I agree