Application Step 1 of 6 16% Main Applicant InformationName* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Home Phone*Cell PhoneAddress* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Social Insurance Number* Driver's License Number* Do you own or rent your home?*SelectRentOwnHow long have you lived at your current address?*SelectLess than 2 yearsMore than 2 yearsPrevious Address (If you have lived at your current address for less than two years) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Have you ever filed bankruptcy or a consumer proposal?*SelectYesNoIf yes, when did you file bankruptcy / consumer proposal?* If yes provide details about your bankruptcy or consumer proposal (type, status, etc.)* Have you ever had a vehicle repossessed?*SelectYesNoIf yes, when and why?* Do you have any "Pay Day" loans?*SelectYesNoIf yes, how much do you owe?* Employment / Business InformationAre you the Owner / Operator?*SelectYesNoAre you Self Employed?*SelectYesNoEmployer / Broker Name* Length of Employment* Employer Contact Name* Employer Phone NumberHow many years have you been an owner/operator?* How many years have you been a Class 8 Driver?* If you own a Company, what is the name? Date Business Established?* Sole Proprietor or Incorporation?SelectSole ProprietorIncorporationBusiness or Incorporation Number Does the business use an operating or trading name?*SelectYesNoWhat is your Fiscal Year End? If yes, what is the name?* Operating Authorities held by Applicant*SelectYesNo(i.e. plates & insurance) Held by Employer/Broker*SelectYesNoDo you own, lease or operate any other commercial vehicles?*SelectYesNoIf yes, how many?* Are any of your assets currently pledged as collateral*SelectYesNoIf yes, to whom?* Is it under a General Security Agreement (GSA)?*SelectYesNoAre you current with your remittances to the CRA for the following: Personal Taxes*SelectYesNoCorporate Taxes*SelectYesNoSource Remittances*SelectYesNoGST/HST Filings*SelectYesNoIf you answered No to any of the above is there an arrangement in place with the CRA?*SelectYesNoWhat are the balances due?* Are you willing to provide copies of your notice of assessments (NOA) to support the above?*SelectYesNoPersonal ReferencePersonal Reference Name* First Last Phone* Vehicle InformationYear* Make* Model* Vehicle's VIN* Estimate Acquisition Cost*Mileage in Kilometres* What type of financing are you interested in?*SelectLeasePurchasePurchase/Leaseback Dealer / Repairer InformationReferring Repairer / Dealer* Dealer Contact Name* Phone*How did you hear about Global Leasing Group or EZ Repair Loan? Personal Net Worth StatementAssetsCash on Hand*Real Estate*Investments - Stocks & Bonds*Life Insurance - Attach Details*Vehicles (specify)*Vehicles (specify)*Other Assets*Total Assets*LiabilitiesMortgage*Loan (Specify)*Line of Credit (Specify)*Credit Card (Specify)*Income Tax Unpaid*Property Tax Unpaid*Other Liabilities (List Below)*Total Liabilities*Net Worth*Gross Annual IncomeSalary, Wages, Commissions etc.*Business or Professional Income*Rental Income*Dividends & Interest*Other Income (specify)*Total Gross Income*Annual ExpendituresProperty Taxes*Income Taxes*Loan Payments*Mortgage Payments*Insurance Payments*Payments on Charge Accounts*Estimated Living Expenses*Other*Total Expenditures*Net Disposable Income* Optional DocumentsSubmitting these documents is optional, but having them will help us process your application more quickly. Information to follow for Initial Approval: To accompany loan application for Initial Approval: Completed Loan Application Copy of Vehicle Ownership Proof of Insurance (Copy of Certificate) Copy of Debtor’s Driver’s License Copy of Dealer estimate or quote Information to follow for Final Approval: Copy of Lease Agreement (if applicable) Copy of Articles of Incorporation and/or Business Registration (if applicable) Copy of Broker Agreement or Transportation Authorities (if applicable) 2nd Piece of identification i.e. Citizenship, Birth Certificate, Passport or Social Insurance Number (SIN) Proof of wage/income and Financial or Bank Statements Void Cheque (for pre-authorized payments) Copy of Final Dealer invoice signed by owner File Drop files here or Select files Max. file size: 20 MB, Max. files: 20. Acknowledgement*The above statements in this application are true and accurate to the best of my information and belief. I have the authority to bind the Company and this serves as my permission for the release of any information regarding this application for the purpose of both personal or corporate credit investigation. I acknowledge and consent to the collection and use of personal information in this application by Global Leasing Group Ltd. in connection with the granting or consideration of credit including credit reportin g agencies. I agree to the privacy statement and terms and conditions outlined on the Global Leasing Group Ltd. website www.globalleasinggroup.com. I acknowledge that the provision of incorrect information or the misrepresentation of any information provided on this form will result in Global Leasing Group Ltd. withdrawing any offer of financing. I certify that all the information I've provided is correct.Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Other Shareholders & OfficersIf different from main applicant, if more than one please attach additional pages.Is there business partner information you'd like to submit?*SelectYesNoPartner Name* First Last Partner Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Partner Social Insurance Number* Partner Driver's License Number* Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920EmailThis field is for validation purposes and should be left unchanged.