Furniture Financing Application

First Name (required)

Last Name (required)

Maiden Name

Your Email (required)

Your Telephone (required)

Social Insurance Number

Driver's License Number (required)

Date of Birth [MM/DD/YYYY] (Required)

Employment Status (Required)


Position

Years Employed


Your Net Pay (Required)

How often do you get paid? (Required)


Province (Required)

Street Address

City

Postal Code

Have a partner/spouse ?
YesNo

First name of your partner/spouse

Last name of your partner/spouse

Driver license number of your partner/spouse

SIN of your partner/spouse

Date of Birth of your partner/spouse (mm/dd/yyyy)

Upon clicking the submit button I, hereby agree that 49792 Newfoundland and Labrador Ltd may obtain a consumer or other report containing personal and credit information from a credit-re-porting agency in connection with this application and I authorize the release of such information. If this application is approved I authorize 49792 Newfoundland and Labrador Ltd to obtain and disclose information on an ongoing basis from credit bureaus from information previously collected.