EQUIPMENT FINANCING

Financing Application

Take the next step toward your equipment purchase. Complete the financing application below to get started.

Finance Application Information

Asterisk indicates required field

Finance type *

Statement of consent

I certify that the information provided by me is correct. I also understand that you
will be checking with credit reporting agencies. I authorize an investigation of my credit and employment
history and the release of information about my credit experience. Please initial below to indicate that you
have received a copy of our Privacy Notice and agree to all of the above. YOUR CREDIT APPLICATION IS GOING
THROUGH A SECURE WEBSITE AND YOUR IDENTITY IS SAFE

Initial here *

Your Contact Information

Name As It Appears on Driver's License

First Name *

Middle Name

Last Name *

Driver's License *

Driver's License Expiration Date *

Phone *

Work phone*

Residence phone *

Email *

SIN *

Male / Female

Date of Birth *

Marital Status

Unit Info

Unit Name

Unit Price

Physical Address Information

Physical Address *

City *

Province *

Postal Code *

County *

Housing Information

Do you Rent or Own your home, or other? *

LandLord / Mortgage Holder

Rent / Mortgage Monthly Amount *

Mortgage Balance *

Time at current residence (Years) *

Time at current residence (Months) *

Banking Information

Name Of Bank

Account Types

Name Of Bank

Account Types

Employer Information

Occupation *

Employer Name *

Employer Address *

Employer City *

Employer Province *

Employer Postal Code *

Employer Phone *

Salary (Annually Gross) *

Time at Employer (Years) *

Time at Employer (Months) *

Type of Employment

Other Income

Other Income Frequency

Additional Comments

Please include any information that you feel may help us process your
application.*

References

Name

Phone

City

Province

Name

Phone

City

Province

Name

Phone

City

Province

Name

Phone

City

Province

Financing Application

Finance Application Information

Statement of consent

If you are applying as a co-applicant for someone who has already submitted a credit form, please indicate
their
name.

Your Contact Information

Unit Info

Physical Address Information

Housing Information

Previous Residence (If less than 2 years at Current Residence)

Banking Information

Employer Information

Previous Employer Information (If less than 2 years at Current Employer)

Additional Comments

References

Podolinsky
Equipment Ltd.

Petrolia Location

Glencoe Location

Quick Links

Financing Application

Finance Application Information

Statement of consent

If you are applying as a co-applicant for someone who has already submitted a credit form, please indicate their name.

Your Contact Information

Unit Info

Physical Address Information

Housing Information

Previous Residence (If less than 2 years at Current Residence)

Banking Information

Employer Information

Previous Employer Information (If less than 2 years at Current Employer)

Additional Comments

References

If you are applying as a co-applicant for someone who has already submitted a credit form, please indicate
their
name.