Luis Aguinaga - Real Estate Agent, Agent Inmobilier, Mortgage Broker, Courtier Hypotecaire, Agente Inmobiliario

Please enter your data, especially the boxes "required" marked with (R)

Mr Mrs
First Name :(R)
Last Name :(R)
Date of Birth :	Day : Month : Year :
Drivers License Number :		Social Ins. number :(R) - -
Medical Card Number :
Marital Status :
Children:	Child 1 - age :	click here to add an extra childs age click here to remove a child.
Provincial allowance
Federal allowance :
Home Phone :(R)
Cell Phone :
Email : (R)
Contact Preference :	By Phone By Email
Select Language :	English French Spanish Other
First Time Buyer? :	Yes No
Address *:	Number App.
Street :
Postal Code :
City :
Province :
Status *:	Rent Own
How Long?	Less than 2 years* More than 2 years	* Please note that if you have lived in your current address
	*Is there still a Mortgage? Yes No	less than 2 years, it is necessary to indicate your previous
Value of Home :		address in the allocated section bellow
Financial Institution :
Current debt :
Monthly Payment :

Please complete your previous address
Address :	Number : App.:
Street :
Postal Code :
City :
Province :
	*Is there still a Mortgage? Yes No
Value of the Home :
Financial Institution :
Monthly Payment :

SELF-EMPLOYED?	Yes No
Operating as :
Company Type :
Gross Revenue :

EMPLOYER NAME :
Type :	Full-Time Part-Time
Address :
Phone Number :	Ext.
Fax Number :
Email :
Industry Sector :
Time at Job :
Time in the same field :	Less than 2 years* More than 2 years	* Please note that if you have worked in your current
Family Allowance :	Federal Provincial	employment less than 2 years, it is necessary to indicate
ASSETS :	Establishing net worth	your previous employment in the allocated section bellow
RRSP(s): Indicate :
Financial Institution :
Vehicle(s) : Type :
Year :
Approx. value :
Financial Institution :
Savings :
Checking :
GIC :
TFSA :
Value of Stocks/Bonds/ Mutual Fonds

Please complete your previous Employment
SEFL-EMPLOYED?	Yes No
Operating as :
Company Type :
Gross Revenue :
EMPLOYER NAME :
Address :
Phone Number :	Ext.
Fax Number :
Email :
Industry Sector :
Time at Job :
Time in the same field :

		* Indicates Notes (R) Indicates required fields