The MIM team wishes to give you the best service possible. In order for MIM to process your equipment leasing credit application within 24 hrs we require the documents listed below.

Commercial Applicant

  • Financial Statements (minimum 2 year comparable)
  • Interim Statements (Usually within the last 3 months)
  • Equipment List
  • A /R & A/P listing

Sole Proprietor

  • Statement of Business Activities
  • Interim Statements
  • Equipment List
  • Accounts Receivable List
Download English PDF Form
Download French PDF Form

1. Customer Information

Company Name: *

Business Address (Street/City/Province) *

Trade Name

BIN number

Phone: *

Fax:

Years in Business:

Date of Incorporation:

Province of Incorporation:

2. Owner / Proprietor Information

Name:

Social Insurance Number:

Home address:

Years at this address:

Do you own the house or rent:

Date of birth:

% of Ownership:

Marital Status:

Number of dependents:

Name of spouse:

Home phone number:

Cell Phone number:

3. Marketplace Information - Please list three largest clients.

(1)COMPANY NAME

(1)YEARS

(1)ADDRESS

(1)% OF ANNUAL SALES

(2)  COMPANY NAME

(2)  YEARS

(2)  ADDRESS

(2)  % OF ANNUAL SALES

(3)  COMPANY NAME

(3)  YEARS

(3)  ADDRESS

(3)  % OF ANNUAL SALES

Terms & Conditions

I, the applicant, warrant and confirm that the information given herein is true and correct and I understand that it is being used to determine my credit responsibility. Money in Motion Inc., or it's affiliates {collectively "Money in Motion"} are authorized to obtain, and any source is authorized to disclose, any information Money in Motion may require at any time relative to this application from each source to which Money in Motion may apply and each such source is hereby authorized to provide Money in Motion with such information. Money in Motion is furthermore authorized to disclose in response to direct inquiries from any other lender or any Credit Bureau, such information on my loaning account as you consider appropriate and I agree to Indemnify Money in Motion 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 Money in Motion or it's representative 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 creation 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, about promotions or other opportunities by whatever means (including direct marketing) offered by Money in Motion, 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 Money in Motion collection, use and disclosure of my personal information shall be done in accordance with its Privacy Code and applicable law and herby consent to such collection, use and disclosure.

I specifically acknowledge that Money in Motion 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 institutes and credit providers; government and other regulatory bodies' and any individuals or organizations that (I) 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 Money in Motion may assign this transaction in whole or part from time to time and agree that any personal information collected any be made available to any such proposed assignee or the banker or funder or affiliate of Money in Motion.

Dated On:

Applicant Signature:

Co-Applicant Signature:

4. Personal Net Worth Statement

ASSETS
CASH:
ACCOUNTS RECEIVABLES:
REAL ESTATE(DESCRIPTION)
1
2
3
RRSP
STOCKS, BONDS & INVESTMENTS
CASH SURRENDER VALUE OF LIFE INSURANCE
AUTOMOBILES /BOATS /SNOWMOBILES
1
2
3
4
TOTAL ASSETS:
LIABILITY
CREDIT CARD(1):
CREDIT CARD(2):
MORTGAGE (Please list Bank or Institute)
1
2
3
MORTGAGE RENEWAL RATE
OTHER DEBTS:
LOANS:
1
2
3
4
TOTAL LIABILITY:
PERSONAL NET WORTH: $
(TOTAL ASSETS - TOTAL LIABILITIES = PERSONAL NET WORTH)
Have you ever declared bankruptcy?
Have you written any N.F.S cheques in the past 3 years?
Have you had any judgment or Legal Proceedings against you?
If you answered YES to any of the above questions, please provide detail here.

5. Terms Desired

TERM DESIRED (I.E. 3,4,5 YEARS)

SKIP PAYMENTS REQUIRED?

IF YES, WHICH MONTHS REQUIRED?

ESTIMATED MONTHLY PAYMENT:

ESTIMATED DOWN PAYMENT AVAILABLE:

6. Applicant's Signature

APPLICANT SIGNATURE:

CO-APPLICANT SIGNATURE

DATED ON:

Thank you

One of our representatives will get back to you shortly.