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PART A

VENDOR

Equipment Description

Sales Rep

Phone Number

Equipment Cost $

Lease Term Requested (in months)

APPLICANT
Name
DOB
SIN (optional)
Home Address
City/Province
Postal Code
Home #
Cell #
Email Address
Employer Name
Employer Address
Work #
Are you self employed?
YesNo
If yes, which of the following applies to you business:
Sole ProprietorPartnershipLimited or Incorporated
Total Income

PART B

COMPANY INFORMATION (FOR LIMITED AND INCORPORATED COMPANIES)
Full Company Name :

Address :
City
Province
Postal Code
Phone #

Fax #
Type of Business
Business Start Date
Email Address

The undersigned certifies the above information to be true and correct and hereby authorizes and instructs Weslease of Canada Ltd., its nominee or any person, credit agency or credit grantor to compile, furnish and disclose such information as may be required to approve the credit applied for herein. The equipment to be financed is intended for business or professional use and under no circumstances is this to be considered
an application for consumer financing.

Authorization

Name

Date