Personal Net Worth Form

Get a head start on finalizing your application by completing this Personal Net Worth form. This will help speed up your approval process and get you your equipment faster!

Name*
First Last
Date of Birth*
Month
Day
Year
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Name*
Occupation*
Number of Years in Business
Assets
Cash
Stock Bonds
RRSP
Vehicles
Real Estate
Other Asset #1
Specify (Asset #1)
Other Asset #2
Specify (Asset #2)
Other Asset #3
Specify (Asset #3)
Liabilities
Credit Cards
Line of Credit
Vehicle Loans or Leases
Mortgages
Misc. Loans
Taxes, Income or Property
Other Liabilities
Total Assets
Total Liabilities
Net Worth
Monthly Income
Salaries/Wages
Dividend Income
Rental Income
Business or Professional Income
Other Income
Monthly Expenses
Mortgage/Rent
Loan Installments
Credit Cards
Lease Payments
Other Expenses
Total Income
Total Expenses
Cash Surplus/Deficiency
I certify that the above statement of my property and debts is true.*
I Consent to
the collection, use and disclosure of my personal information for the purpose of credit adjudication by the Lessor and its funders and to enable the lessor and its assignees to provide leasing services:

and the Lessor and its funders obtaining information from credit reporting agencies and listed references in connection with this application.

This personal net worth statement has been digitally signed by the applicant.
Date*

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