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Required fields are denoted by * and must be completed before submitting this form.

Your Name*: Title:
Street Address: Marital Status:
City: Dependants:
Province: How long in Residence:
Postal Code: Select:
Phone #*: SIN:
Email*: Birth Date*:
Previous address if less than three years
Street Address: City:
Province: Postal Code:
Co-Applicant's Information (if required)
Name: Marital Status:
Birth Date: SIN:
Employment History
  Applicant     Co-Applicant
Name of Employer    
Employer Address    
How Long Employed:    
Your Position Held:    
Annual Income    
Other Income    
Previous employer if less than 3 years with present employer
  Applicant     Co-Applicant
Name of Employer    
Employer Address    
How Long Employed:    
Your Position Held:    
Annual Income    
Other Income    
Your Home
Monthly Payments Including Taxes/Monthly Rent:
Current Mortgages   Home Value:
Mortgage Due Date:   Lender:
Mortgage Balance:   Other Loan:
Assets and Investments
Other Real Estatate (if yes provide address):
Stocks/Bonds:   Term Deposits:
Auto(s) Year and Make:   RRSPs:
Other Assets:
Other Comments on property or other properties owned:
Your loan requirements
Amount to borrow:   Ammortization Period:
Date Funds Needed:   Purpose
Property Information
Street Address
City   Province:
Type of House   Strata fees if any:
Purchase Price:   Down Payment:
Source of Down Payment:
Will the property be occupied by you:
Other Information:

To submit your application please agree to the Privacy/Suitability/consent/Anti-Spam Agreement below and click "Submit".

At Four Corners Mortgages ( FCNR ) takes pride in the policies and procedures used to protect the personal information collected and maintained on behalf of our clients. Access to personal information is granted to our agents under the Personal Information Protection and Electronic Documents Act (PIPEDA).

Collection and Use of Information:
To better understand your financial needs and make you aware of new services that could help you reach your goals, FCNR collects personal information from a variety of sources. Some personal information and some reasons it is collected include, but is not limited to, are: a) Data such as name, address, contact numbers, email contact, income, employment, age, net worth, investment objectives, and banking information; b) Unique identifiers: such as social insurance, driver’s license, passport numbers, etc.; used to fulfill regulatory and other governmental obligations to distinguish you from other clients with similar names; c) Information from a consumer reporting agency or other source, which may include account information and/or information about your creditworthiness. FCNR uses this information to help determine the mortgage product that is suitable for your mortgage needs.

FCNR collects this information in order to provide the services you have requested, and to help us determine how FCNR or other non-affiliated companies may be of service to you.

Guidelines for Disclosure of Information:
a) FCNR may provide information to credit bureau agencies, financial institutions, insurers, private investors, creditor life company etc. b) FCNR shall use the information to determine your financial situation for purposes related to services that you have requested from Four Corners Mortgages. FCNR may also provide the information to others that work for Four Corners Mortgages, but only as needed for the provision of those services. c) FCNR shall use your social insurance number as an aid to identify you with credit bureau agencies and financial institutions for credit history file matching purposes. d) FCNR may use your information to promote Four Corners Mortgages services to you.

FCNR will not use or disclose personal information for purposes other than those for which it was collected, except with the consent of the individual(s) or as required by law. Files are kept a minimum of three (3) years.

Ongoing Commitment:
Confidentiality is the key to a strong relationship and FCNR is committed to protecting your privacy. If you need clarification regarding this policy, please contact Michael Martel, 805-55 Water St. E. Brockville, ON. K6V 1A3.

I/We are aware of:
a) How a variable rate mortgage and its’ applicable mortgage payment may increase without notice within the term of the mortgage. This may affect the ability to make mortgage payments:
b) How terminating or prepaying a mortgage prior to maturity term may involve prepayment penalties. How different mortgage products can vary with various prepayment options.
c) How changes in my/our employment (eg. reduced income), credit, liabilities, etc. may affect the ability to make mortgage payments in the future and/or changes prior to closing could affect me/us not qualifying for the mortgage.
d) The amount of monthly mortgage payment of PI&T will be discussed with my agent based my/our current personal financial obligations (include condo fees if applicable)
e) The benefits of creditor mortgage protection.
f) The inherent risks associated with mortgages. The agent has evaluated my/our needs to assist in determining the most appropriate mortgage including to offer to assist in preparing a budget.

Credit Bureau consent:
I/We the undersigned, declare the information provided is a true and complete representation. I/We understand that it is being used to determine my/our credit responsibility and to evaluate my/our request for credit. I/We authorize Four Corners Mortgages or their designate to obtain a credit report. I/We acknowledge that the completion of a credit application may take time and it might entail additional credit reports. I/We permit additional credit reports for up to six (6) months from the date signed below. I/We also authorize Four Corners Mortgages to exchange such credit information for the purpose of securing credit with potential mortgage lenders, mortgage insurers or other service providers. Four Corners Mortgages may retain the application and credit information.

Canada Anti-Spam Legislation:
Four Corners Mortgages will keep in touch via electronic messaging during your transaction as permitted by the legislation! Four Corners Mortgages also occasionally communicates with its database via electronic messages. The content provides insightful information on mortgages, finances, etc. I/We wish to be kept informed and consent to the receiving of these informative communications for the term of my/our mortgage. I/We can unsubscribe at any time.

I have read and understand the Privacy/Suitability/consent/Anti-Spam Agreement.*

I have read and understand the Canada Anti-Spam Legislation section and consent to the communications.*