Complete Our 2 Minute Application

Javascript is disabled

Javascript is disabled on your browser. Please enable it in order to use this form.

Business Information

Business Type*

Sole Proprietorship

Partnership

Corporation

Company Legal Name*

Company Operating Name

If different from your legal name

Physical Address of Business*

Address

City

Country

Province

Postal Code / Zip Code

Phone

How many Years in Business/Practice

Company Email Address

Principle / Owner Information

Your Legal Name

First Name

Last

Home Address*

Street Address

City

Country

Province/State

Postal Code

Birthday*

Email Address

Social Insurance Number *this form is encrypted

Cell Phone

Are there additional owners? (25% or more ownership)

Yes

2 - Principle / Owner Information

Your Legal Name

First

Last

Home Address*

Street Address

City

Country

Province/State

Postal Code

Birthday*

Social Insurance Number *this form is encrypted

Cell Phone

Equipment

Give us a brief Description of the instrument(s) / equipment you would like to purchase

Description of Instrument(s) / Equipment you would like to purchase

Total Equipment Cost*

Estimate equipment cost if you don't know yet.
* Pre-Tax Cost - taxes will be applied to lease.

Applicant's Signature

Date*

Select Date ×

Agreement and Consent

By submitting this application, the user confirms that each of the applicants, co-lessees and/or guarantors, (including existing lessees and/or guarantors) has:

Consented to the collection, use and disclosure of personal information for the purposes of credit adjudication by the Lessor/Lender and its funders, to enable the Lessor/Lender and its assignees to provide lease/financial services, administer your contract and promote the products and services of the Lessor/Lender and its affiliates;
Acknowledged that providing a social insurance number is optional and not a mandatory condition to obtaining a credit review;
Consented to the Lessor/Lender and its funders and assignees obtaining information relating to the applicants, co-lessees and/or any guarantors from all credit reporting agencies and other third parties in connection with this application;
The User confirms the information submitted is accurate and correct for the Lessor/Lender to reliably adjudicate the application. The User may be held responsible for the transmittance of incorrect information.

I've read this Agreement and Consent to Collection, Use, Credit Check, and Disclosure of Personal Information*

Yes

Business Information

Principle / Owner Information

2 - Principle / Owner Information

Equipment

Applicant's Signature

Agreement and Consent

Your form has been submitted