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As a dedicated Mortgage Professional my career is built on providing exceptional service throughout your mortgage transaction and beyond.

With access to Canada’s top lenders I can provide unbiased advice to ensure your mortgage strategy is tailored to your individual needs. Whether your credit is good, or you are rebuilding your credit, you have little or no money down or face the challenges of self-employment there is a lender to suit your needs. Best of all, there is no cost to you! (OAC)*

APPLY ON-LINE OR CALL TODAY

TO BOOK YOUR PERSONAL CONSULTATION 
Phone: 519-771-1305
Fax: 519-756-3233

Applicant/Co-Applicant Information  (Please complete all fields)
 Applicant Information
TitleMr. Mrs. Ms Miss
First Name 
Last Name
Street Address
Suite/Apt
City
Province
Postal Code
Years at this address
Rent/Own/Other  
Rent: /month
E-mail
Previous Address
How Long
Home Phone
Business Phone
Date of Birth  
ex.(dd/mm/yyyy)
 
Social Ins. Number  
ex.(xxx - xxx - xxx)
Dependents Ages
Employer
Occupation
Years at this employer
Annual Income
Income Frequency
Previous Employer
Previous Occupation
Years at Previous Employer
Level of Education
Bank/Trust Name
Branch
Type of Account
Have you declared bankruptcy in last 7yrs.Yes  No
Reason for Bankruptcy
Amount of Bankruptcy
Date of Discharge
Amount of Bankruptcy
Other Income  
How long?
Overtime  
How long?
Child Support  
How long?
Received Paid
Rental Income
Co-Applicant Information
Mr. Mrs. Ms Miss
 
Rent: /month

 

 
Ages
Yes  No
 
How long?
 
How long?
 
How long?
Received Paid
 
Assets
Applicant Information Co-Applicant Information
Cash in Bank$
Real Estate$
 Address
 
Locked in/Cashable$
Automobile$
Make/Model
Owned Leased
Automobile$
Make/Model
Owned Leased
GIC's$
RRSP$
           Mutual Funds$
Gift$
Other Assets $
Total Assets$
$
$
Address
 
$
$
Make/Model
Owned Leased
$
Make/Model
Owned Leased
$
$
$
$
$
$
Liabilities
Applicant Information Co-Applicant Information
   Balance  Monthly Payment
Bank Loans$  $
Bank Loans$$
Bank Loans$$
Mortgages$$
Credit Cards$$
Credit Cards$$
Credit Cards$$
Car Loans$$
Other Loans$$
               Total Liabilities$$
  Balance  Monthly Payment
$  $
$$
$$
$$
$$
$$
$$
$$
$$
$$
 
Is there any additional information we need to know: 
Do you have any questions?
 
I/We Have the sum of $ available for a down payment.
 
I/We require a mortgage in the range.
 
I/We would like to have our mortgage pre aproved 
 

You certify that the information provided is true and accurate, that all debts are current and in good standing, that you have no outstanding jugments and that you have not declared bankruptcy in the past 7 years.  You authorize us to obtain information about you as permitted by law.

I agree [Applicant]        I Agree [Co-Applicant]

 
    

 
100% Club Achiever, Member of Re/Max Hall of Fame Wally Dufrat - Sales Rep
Re/Max Twin City Realty Inc., Brokerage
President's Club Achiever, Hall of Fame Award
515 Park Road North. Brantford N3R 7K8
Phone: 519-752-5400 Cell: 519-761-7400 Fax: 519-752-3400
Toll Free: 877-759-5900 wallydufrat@remax.net
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