CONSUMER CREDIT APPLICATION

BORROWER INFORMATION

At Home Address Since

Time at Previous Address (Years)

Type of Housing

Joint Ownership
Sole Ownership
Rent
No Cost Accommodation

Monthly Mortgage/Rent

Income Type
Commission Pension Salaried Self-Employed

CO-BORROWER INFORMATION

At Home Address Since

Time at Previous Address (Years)

Type of Housing

Joint Ownership
Sole Ownership
Rent
No Cost Accommodation

Monthly Mortgage/Rent

Income Type
Commission Pension Salaried Self-Employed

EQUIPMENT DETAILS

Goods & Services Financed:

1.
Cost: $
2.
Cost: $
3.
Cost: $
Insurance: Salaried Self-Employed
Cost: $

Total Equipment & Insurance Cost:

Down Payment:

Term:

I/we certify that all the information in this application is true and complete. I/we acknowledge that all the personal information gathered may be used by IndCom Leasing Inc., its funders, agents and assigns, to assess my credit worthiness, provide products, and administrate the contract and to perform services as may be requested by me. IndCom Leasing Inc. may also disclose my personal information to third parties such as but not limited to credit reporting agencies, financial institutions, financing companies, securitization organizations and my insurance agent or company. IndCom Leasing Inc. may also disclose my personal information where they are required or permitted by law to do so. Subject to legal and contractual requirements, you may refuse or withdraw your consent to certain of the identified purposes at any time by contacting the IndCom Leasing Inc., Chief Privacy Officer. By executing this document below, I have consented to these uses and disclosures.