Printable Mortgage Application Form
Mail to: CENTURY 21 Dominion Realty Inc.
27 Armthorpe Road, Unit # 2,
Brampton, Ontario, Canada L6T 5M4

Fax to:

 905-792-7600
For a free quote from Dominion Realty, just fax or mail this form telling us about yourself and your mortgage needs, and we'll contact you with the best rate available!
Mortgage requirements: (check one only)
First mortgage Second mortgage Third mortgage
Assumption of mortgage Refinance mortgage  
Other     Specify other:
I/we have the sum of available for a down payment.
I/we require a type of home in the $ price range.
Do you require mortgage pre-approval?     yes         no
Personal information:
  Applicant: Co-applicant:
Name:
E-mail:
Address:
 
 
 
Apt. or suite:
City:
Province:
Postal code:
Years at address:
Presently own? yes      no     rent yes      no     rent
Previous address:
 
Phone (home):
Phone (business):
Date of birth:
Marital status:
# dependents:
SIN:
Employer:
Employer address:
 
 
Occupation:
Years at employer:
If above <3 yrs., give
previous employer:
 
 
Yrs. at prev. employer:
Annual income:
Income type:
Bank:
Bank address:
 
 
Property information:
Municipal address:
 
 
Property type: i.e. detached, semi, townhouse, condo, etc.
Lot: Plan:
Lot size (m2): Annual taxes:
# Rooms: # Bedrooms:
# Bathrooms: # Kitchens:
Garage: yes    no # Cars:
Heating type: Water:
Sewers: Apartment: yes    no
Basement: Condo fees:
Additional Information:
Is there any additional information we need to know?
Do you have any questions?
Agreement and Authorization:
I/we hereby authorize Dominion Realty Inc. hereafter referred to as "the Broker" to arrange on my/our behalf the loans described above and certify that the above information is furnished with the intent that it be relied upon by the Broker to obtain said credit, is true and correct and: i) Agree (if this application is for a loan to be secured by a mortgage) that the evaluation, inspection and legal expenses incidental to this application will be paid by me/us and that I/we am/are not in arrears on my/our present mortgage(s). ii) The above information includes all my/our debts and that I/we have no current unsatisfied judgments and that I/we have not declared bankruptcy in the past six years and that all my/our outstanding credits are current and in good standing. iii) I/we also acknowledge that the Broker may also be receiving a fee in respect to the arranging of this loan and I/we hereby waive any right to deny or dispute the Broker from receiving said fee. iv) In connection with any application for credit, I/we take notice that you may be procuring and may be referring to a consumer report respecting me/us containing personal information and I/we hereby consent hereto and to the disclosure of such information to other credit grantors or consumer reporting agency and to retain this application for the Brokers records.
I agree (applicant)    I agree (co-applicant)
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