Club Prêt Online Request
211, Jarry E., Montreal, Quebec H2P 1T6 Tel.:(514) 282-7509, Fax:(514) 282-6382
email: demande@clubpret.qc.ca

IDENTIFICATION Borrower 1 

 Request date: dd/mm/yyyy
Name File number Member number:
Surname Employee number Date of  birth: dd/mm/yyyy
Address Agent: Ext. SIN:
Previous Addr. if less than 3 years Home phone: Civil Status:
Work phone: Sex:
E-Mail address Other  phone: Number of  persons in your charge: 
Dependants years of  birth:
Owner Tenant
IDENTIFICATION Borrower 2 Date of birth: dd/mm/yyyy
Name Ext. SIN:
Surname Home phone: Civil Status:
Address Work phone: Sex:
Previous Addr. if less than 3 years Other  phone:  Number of  persons in your charge: 
Dependants years of  birth:
Owner Tenant
REVENUES Borrower 1
Name of employer Since:  dd/mm/yyyy Position
Employer Address  Gross $ Net  $
Previous employer if les than 3 years Permanent Temporary Contractual Part Time
Other revenue: Gross $ Net $
REVENUES Borrower 2
Name of employer Since:  dd/mm/yyyy Position
Employer Address  Gross $ Net $
Previous employer if les than 3 years Permanent Temporary Contractual Part Time
Other revenue: Gross $ Net $
TOTAL:  Gross $ Net $
Club Prêt DEMAND ON LINE
ASSETS Borrower 1 or 2 Name and address of institution Account No. Maturity date Prop. % Present Value$
Investments (Savings, deposits, RRSP etc.
Real Estate Borrower 1 or 2 Address Mun. Evaluation $ Taxes / year $ Prop. % Building Value$
Cars, boats, motorcycle, etc. Borrower 1 or 2 Model, year Prop. % Value $
Total assets from ANNEXES if applicable   $
                     TOTAL ASSETS $
DEBTS Borrower 1 or 2 Creditors, name and address Card number Amount of loan $ Monthly Payment Prop % Balance $
credit cards
mortgages loans, credit margins etc.
Other payments Monthly Payment $  
Alimony, pension,  car rental, income tax, etc.  
 
Total Monthly Payment and balance from ANNEXES if applicable  $
Total monthly payments $ 
NET WORTH  (Assets - Debts) $

TOTAL DEBTS $
Reason for Loan
Club Prêt Mortgage counter Real estate given in guarantee
PURCHASE   TRANSFER  REFINANCING  CMHC
Amount of mortgage requested $ Payments$
Term requested
Amortization (Years)
Interest rate  % Payments with CMHC premium:$
Purchase cost Municipal evaluation Annual taxes Monthly heating Condo fees / month
$ $ $ $ $
CMHC premium Loan with CMHC 1 disbursement Loan with CMHC 2 disbursement
$ $ $
As per ABD ratio: Capacity:$ Required rev.:$
As per ATD ratio: Capacity:$ Required rev.:$

If two strips are green=good,  if one strip is yellow=acceptable,  if one strip is red=difficult
Have you ever been subject to bankruptcy or insolvability laws?  Have you ever been subject to voluntary deposits laws ?
Yes No Yes No
Are you surety for any debtor? Has any judgment been obtained against you ?
Yes No Yes No
If yes, please explain:
REFERENCES
Name Name
Address Address
Phone number Phone number
Relation Relation

Declarations: I recognize that Club prêt or any person or lender authorized by Club Prêt will have the right not to give effect to these present even after having made an engagement or commitment in the following cases: If I do not follow through to the present demand within 30 days or it's acceptation or if I neglect to supply proper titles and other documents required or if I neglect to comply with the conditions stipulated by Club Prêt or by any institution authorized by Club Prêt in reference to the present or if the sums to be disbursed are to be used to other means then the ones described in the present. I agree that I will be responsible of the evaluation and inspection fees applicable to this request except if I act as caution. I declare and guarantee that all the information contained in the present are true, exact in all aspects, that I have no other creditors then the ones that are declared herein and that I know that the answer given to the present demand or loan or caution will be based on those information's. I declare that I have not dissimulated any information that may influence the decision.
Agreement: I consent that Club Prêt or any institution authorized by Club Prêt may obtain from any person or organization that may have information relevant to my solvability or my financial situation and relevant to the present loan request, and for as long as I will continue my business relation with Club Prêt or any lender referred by Club Prêt following these present and for all periods of said loan or any renewal, including any update and any modification in the business relation with Club Prêt or lender. I agree to divulge to any person contacted to release all information even if in a closed or inactive file. I also consent to the divulgation to any lender, information agent, co borrower and caution present and future that all of the information concerning the present demand and to any engagement of which I may be liable. I also agree and recognize that Club Prêt will receive a remuneration from lending institutions following the completion of the present. The present consent is to be considered as a contentment required by any law concerning the protection of personal information

Click here to indicate acceptance of the above agreement.
     
 
Attach Confirmations:
Employment confirmation Notice of fiscal assessment
Municipal taxes School taxes
RRSP balance Bank balance
Investments balance Balance of actual mortgage
Alimony judgment Leases
Purchase offer Listing
NOTES:
Club Prêt Banking ratios
ABD Mortgage payments Gross revenues ABD Objective Capacity Required Revenues
ATD
Monthly obligations Monthly payments Gross Revenues Objective Capacity Required Revenues
Indebtness ratio Total assets Ratio of indebtness Ratio of indebtness no 2
Liquidity ratio Short term liquidity Monthly financial engagements Liquidity ratio 1
Net tangible value Assets readjusted Debts Net tangible value