Shenher Insurance

Mortgage Quote

Applicant Information

Co-Applicant Information

Name

Street Address

Suite/Apt

City

Province

Postal Code

Years at this address

E-Mail

eg: yourname@host.com

Home Phone

Business Phone

Date of Birth

Social Ins. Number

- -

Employer

Occupation

Years at this employer

Annual Income

Assets		Liabilities	Balance	Monthly Payment
Cash in Bank	$	Bank Loans	$	$
Real Estate	$	Mortgages	$	$
Automobile	$	Credit Cards	$	$
Other Assets	$	Other Loans	$	$
Total Assets	$	Total Liabilities	$	$

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 in the range.

I / We would like to have our mortgage preapproved

Privacy Protections and Client Consent

We are clients of each of:

Mortgage Intelligence Inc. ( "Mortgage Intelligence" ), and
Michael Shenher ( "My Independent Broker" )

for these purposes:

		arranging and/or renewing loan(s) / mortgage(s), [required]
		considering group creditor insurance for which Mortgage Intelligence or its affiliate is the group policy holder, (optional)
		considering other products offered or approved by Mortgage Intelligence or its affiliates that may be of interest to me/us. (optional)

Consents

We understand a) My Independent Broker maintains his/her own client information and is not an employee or agent of Mortgage Intelligence Inc, b) Mortgage Intelligence has individuals (including My Independent Broker) acting for it, c) our Mortgage Intelligence File (containing our personal information) will be kept physically at the office of My Independent Broker until a loan/mortgage is funded, after which it is sent a Mortgage Intelligence corporate or licensed office for review and storage, and electronically on Mortgage Intelligence computer systems, d) access to this File is restricted to personnel having a need to deal with the File, and e) we can review and correct personal information in this File or our personal contact information in My Independent Broker's client contact database.

Consents

My Independent Broker can retain and use our personal contact information for these purposes for seven years after the last loan/mortgage application made on our behalf.

Mortgage Intelligence can use our personal information for these purposes and can:

> obtain personal information about me/us from consumer reporting agencies, credit bureaus, and real estate appraisers, and (if more than one client) about either of us from the other,
> provide our personal information to third parties for these purposes (eg. lenders).

Each lender considering our applications from Mortgage Intelligence can:

> obtain personal information about me/us from consumer reporting agencies, credit bureaus, and real estate appraisers, and (if more than one client) about either of us from the other,
> ensure the accuracy of our personal information by contacting third parties.

Our personal information can be retained by Mortgage Intelligence and by these lenders for seven years after:

> the last loan/mortgage application made on our behalf, or
> the end of the term of the loan/mortgage,

whichever is later.

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 Mortgage Intelligence Inc. 
2. We certify that the information provided is true and accurate, that all our debts are current and in good standing, that we have no outstanding judgments, and that we have not declared bankruptcy in the last 6 years. 
3. We acknowledge that you may be receiving a finder's fee from a lender in respect of arranging a mortgage/loan and we hereby waive any right to deny or dispute our receiving said fee. 
4. We acknowledge that the evaluation, inspection and legal expenses incidental to this application will be paid by us.
5. We will not make any claims against you for any failure to obtain a loan / mortgage commitment, or for any actions or omissions to act by any lender.
6. To authenticate this transaction our computer I.P. Address has been recorded as 142.165.49.65
7. In consideration of your acting for us, we agree to the terms and provisions listed in this Privacy Protection and Client Consent.

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

Send Using Our Secure Server!
This can take up to 2 minutes to process.