1st NetMortgage

	Applicant		Co-Applicant
	Name		Name
	Address		Address
	City		City
	Province		Province
	Postal Code		Postal Code

	Previous Address If Less Than 3 Years
	Applicant					Co-Applicant
	Address					Address
	City					City
	Province					Province
	Postal Code					Postal Code

Additional Information
Applicant			Co-Applicant
Telephone	Home	Business	Telephone	Home	Business
E-Mail			E-Mail
Date of Birth			Date of Birth
Social Insurance			Social Insurance
Employer			Employer
Occupation			Occupation
Years of Service			Years of Service
Salary			Salary
Other Income			Other Income

Assets			Liabilities
Institution		Balance/Value	Institution		Balance	Monthly Payments
	Cash			Loans
	Property			Mortgage
	Vehicals			Credit Card
	RRSP			Credit Card
	Other Assets			Credit Card
				Other Loans

	Total			Total Liabilities

Net Worth

More than one property please provides details
	Property Value	Mortgage	Monthly payment
Property 1
Property 2
Property 3
Property 4
Property 5

Details of other incomes
	Income Details	Amount
Income 1
Income 2
Income 3
Income 4
Income 5

	Questions / Concerns / Comments

By submitting I/we hereby authorize 1st NetGroup to arrange on my/our behalf the loan/mortgage described above and certify that the above information which is furnished with the intent that it be relied upon by the 1st NetGroup to obtain said credit is true and corrent and

The above information includes all my/our debts and that we have no current unsatisfied judgements and that I/we have not declared bankruptcy in the last 6 years and that all my/our outstanding credits are in good standings.

I/we also acknowledge that the 1st NetGroup may also be receiving a fee in the arranging of this loan and I/we hereby waive any right to deny or dispute 1st NetGroup from reveiving said fee.

In connection with my application for credit, I'we hereby take notice that you may be procuring and my referring to a consumer report respecting me/us containing personal information and I/we hereby consent there to and to the disclosure of such information to other credit grantors or consumer reporting agency and to retain the application for the 1st Net Records