Admiralty - LEASING

SELECT ONE: Business Lease Application Personal Lease Application

Vendor Information

Vendor Company Name:
Sales Rep. Title:
Sales Rep. Name:
Address:
Address 2:
City:
Province:
Postal Code:
Phone:
Fax:
Mobile:
Email Address:
Equipment Description:
Equipment:
Amount:
Prefered Term:

Company Information

Company Legal Name:
Company's Trade Name:
D.B.A.:
Contact's Title:
Contact Name:
Address:
Address 2:
City:
Province:
Postal Code:
Phone:
Fax:
Additional Details:
Business Start Date:
Type of Business:
Structure:
If 'Other' please indicate:
Years Under Current Ownership:

Personal Information

Title:
Legal First Name:
Legal Last Name:
Email Address:
Home Address:
Address 2:
City:
Province:
Postal Code:
Phone:
Fax:
Mobile:
Date of Birth:
S.I.N.:
Home Owner:
Time at Current Address:
Monthly Income:

ADMIRALTY RESPECTS AND HONOURS YOUR PRIVACY – OUR PRIVACY PROMISE.
By agreeing to these terms, each of you, being the parties signing (including all lessees and all guarantors) agrees that ADMIRALTY LEASING INC. and our affiliates and any third parties acting for us or on our behalf (hereinafter collectively "us", "we" or "our") is authorized and entitled to:

(a) Use your Personal Information (as hereinafter defined) to assess your ability to obtain your lease and to evaluate your ability to meet your financial obligations. This use includes disclosing and exchanging your Personal Information on an on-going basis with credit bureaus, credit reporting agencies and financial institutions or their agents, or to service providers, in order to determine and verify, on an on -going basis, your continuing eligibility for your lease and your continuing ability to meet your financial obligations. This use, disclosure and exchange of your Personal Information will c ontinue as long as either your lease, or any other ADMIRALTY product it is converted to, is outstanding, and will help protect you from fraud and will also protect the integrity of the credit -granting system.

(b) Use, disclose and exchange, on an on-going basis, all the personal information collected by us or delivered by you to us from time to time in connection with your lease and any information obtained by us from time to time pursuant to paragraph (a) above (collectively your "Personal Information") to our affiliates and any third parties acting for us or on our behalf which may fund all or any part of your lease and/or own all or any part of your lease and the security securing your lease from time to time and permit prospective investors in your lease to inspect your Personal Information. You also author ize us to use your personal information for internal statistical analysis purposes. The actions of ADMIRALTY pursuant to paragraphs (a) and (b) above are called the "Primary Purpose" for obtaining, using, exchanging and disclosing your Personal Information. Even though your lease and the security securing your lease may be funded or owned by one or more other organizations, ADMIRALTY and/or o ur affiliates and any third parties acting for us or on our behalf will continue to service your lease. Privacy commissioner website: http:// www.privcom.gc.ca

I AGREE TO THESE TERMS

Employment Information

Gross Monthly Income:
Position:
Employer:
Employer Phone:
Employment Start Date: