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Please complete the following mortgage application. Once complete, click to submit your application. *Denotes required information.

SIMON FELDBAUM

(416) 908-2486

Xpert Mortgage Services Inc.

11685 Yonge Street Suite 301A

Richmond Hill, Ontario L4E 0K7

LICENCE# M09002130

BROKERAGE# 12208

PERSONAL INFORMATION - APPLICANT 1

CURRENT LIVING ADDRESS

PRESENT EMPLOYER

FINANCIAL INFORMATION - YOUR ASSETS

TYPE

WHERE/FINANCIAL INSTITUTION(S)

AMOUNT

FINANCIAL INFORMATION - YOUR LIABILITIES

TYPE

WHERE/FINANCIAL INSTITUTION(S)

BALANCE OWING

MONTHLY PAYMENT

OTHER INFORMATION

ADDITIONAL NOTE FOR FINANCIAL INFORMATION: (MAX. 500 CHARACTERS)

I/we warrant and confirm that the information given in the mortgage application form is true and correct and I/we understand that it is being used to determine my/our credit responsibility. You are authorized to obtain any information you may require for these purposes from other sources (including, for example, credit bureau) and each such source is hereby authorized to provide you with such information. I/we also understand that the information given in the mortgage application form as well as other information you obtain in relation to my credit history may be disclosed to potential mortgage lenders, financial intermediary and mortgage insurers, organizations providing technological or other support services required in relation to this application and any other parties with whom I/we propose to have a financial relationship. ONLINE APPLICATIONS Please read the paragraph above prior to sending completed application. By transmitting the online mortgage application you are accepting the terms of the paragraph noted above.
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