Finance Centre
TRANSACTION DETAILS
Dealer/Supplier:
Equipment Description:
Equipment Cost (pre-tax): $
Term:
Equipment State (New/Used/Year):
COMPANY INFORMATION
> Corporation Proprietorship Partnership Other
Legal Business Name:
Address:
City: State/Province:
Zip/Postal Code: Telephone: - -
Fax: - - Contact:
Email: Website:
Years in Business: Nature of Business:
PRINCIPALS / SHAREHOLDERS INFORMATION
Last Name: First Name:
Telephone: - - Date of Birth:
Address: City:
State/Province: Zip/Postal Code:
Last Name: First Name:
Telephone: - - Date of Birth:
Address: City:
State/Province: Zip/Postal Code:
I/We certify the information I/We have given you about myself and the business is accurate and complete. The undersigned consents to Jocova Financial Services Corporation its successors and assigns ('Jocova') the collection, use, and disclosure to its affiliates, credit bureaus, reporting agencies, financial institutions, and businesses with whom each of the undersigned has had financial relationships and other references proved in support of this application (and disclosure by these parties to Jocova), of the provided herein and credit and financial information obtained from the above sources for the purposes of obtaining and using a credit information report and verifying current and ongoing creditworthiness of each of the undersigned and other information provided in connection with this application. Jocova may disclose credit and financial information connected with this application to future creditors and lenders that request credit references. SIN's or Social Security Number's (if provided) and other personal identifiers will be used solely for matching of credit bureau/reporting agency information and/or verifying the identity of the undersigned. The undersigned consents to the collection, use, and disclosure of personal information by Jocova and the persons referred to in the related lease, finance, or rental agreement for the above purposes and the purposes described in the related lease, finance, or rental agreement.
Acceptance of Applicant Acceptance of Applicant / Co-Applicant (if applicable)
_________________________________________
Signature of Applicant
_________________________________________
Signature of Co-Applicant (if applicable)

FAX: 1.888.546.5152

EMAIL: APPLICATION@JOCOVA.COM
***NOTE: For all applications providing personal information, the applicant(s) must have the Application Form Signed and the consent statment understood.

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