APPLICATION FORM - Empire Citi Properties Ltd.

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Applicant Information

Co-Applicant Information

First Name [required]

Last Name [required]

Street Address [required]

City [required]

Province [required]

Postal Code [required]

Years at this address [required]

E-Mail [required]

Home Phone [required]

Business Phone

Date of Birth [required]

SIN Number

Employer [required]

Occupation [required]

Years at this employer [required]

Annual Income [required]

Additional Comments/Questions
The sum of $ available for deposit or down payment.
How did you find us? (Eg. Refferal, Sun, Herald, Sign, Home Rent etc.)
TYPE THE SPECIFIC PROPERTY OR AREA YOU ARE INTERESTED IN BELOW

Consents
I/We understand that by submitting personal information to Empire Citi Properties I/we consent to and acknowledge all of the following. a) Empire Citi Properties Ltd will herby own client information and is not an employee or agent of any specific lender or credit agency, b) Empire Citi Properties has individuals (including Independent Brokers, lenders, banks, credit agencies and builders/developers) acting for it, c) Empire Citi Properties Files (containing our personal information) will be kept physically at our office and may be shared with other such brokers, lenders, banks credit agencies or builders/developers without further consent. d) Access to this file is restricted to personnel having a need to deal with the file, and e) Empire Citi Properties can review and correct personal information in this file or our personal contact information in its client contact database. Consents Empire Citi Properties can and may retain, collect and use our personal contact information for these purposes for seven years from the initial date of this application made on our behalf. Empire Citi Properties Ltd. can use our personal information for these purposes and can: Obtain personal information about me/us from consumer reporting agencies, credit bureaus, and provide our personal information to third parties for these purposes (eg. Lenders, banks, credit agencies and builder/developers). Each Independent Broker, lender, bank, credit agency and builder/developer considering our applications from Empire Citi Properties Ltd. can: Obtain personal information about me/us from consumer reporting agencies, credit bureaus, and other sources, and (if more than one client) about either of us from the other, And furthermore ensure and verify the accuracy of our personal information by contacting third parties and or other such agencies. Other Terms 1. Throughout this application, "I", "we", "us" and "our" refer to each applicant and co-applicant consenting below; "you" and "your" refer to Empire Citi Properties Ltd. 2. We certify that the information provided is true and accurate to the best of our knowledge. 3. We acknowledge that the evaluation, inspection and legal expenses or other costs incidental to this application will be paid by us. 5. We will not make any claims against Empire Citi Properties Ltd. for any failure to obtain a loan / mortgage commitment, or for any actions or omissions to act by any lender, builder/developer. 6. We understand that by providing this application and information to Empire Citi Properties. a. Empire Citi Properties is not bound or obligated to provide any service to us what so ever. b. Empire Citi Properties is not obligated to perform or negotiate any transactions or enter into any commitments or contracts for itself or us in any such related matters. c. Empire Citi Properties is not responsible for any of the content in the information provided by us in terms of accuracy, errors or reliability. d. Empire Citi Properties Ltd. is a private and independent corporation and will not be responsible for any such costs, claims or damages in relation to any such actions or inactions that may be caused by referring our information to independent Brokers, lenders, banks, credit agencies and builders/developers. 7. In consideration of your acting for us, we have read, understand and agree to the terms and provisions listed in this Privacy Protection and Client Consent.
I agree [Applicant][required] I agree [Co-Applicant]