|
| Please fill-out this online evaluation form and one of our consultant will get back to you as soon as possible. |
|
|
|
Title:
|
First Name: *
|
Last Name:
|
| |
Your E-mail: *
|
Phone: *
|
Cell:
|
What is the best time to Call You?
|
| How did u hear about us? |
| |
Do You Own House?
|
| Yes No |
If Yes, Estimate Value of Your Property:
Estimate Mortgage of Your Property: |
| |
Do You Own any Business?
|
| Yes No |
| If Yes, Is your Business owe any debt? |
| |
| Marital Status:
|
| |
How Many Depandent You Have?
|
| |
| Do You Recieve Child Benefit Tax? |
| What is Your Net Income After Tax? |
| |
Do You have any vehicle?
|
| Yes No |
| If Yes, please describe Make & Model: |
| |
| Do You have any Investment/RRSP ? |
| Do You owe anything to the taxes ? |
| |
| Complete Names of all Creditors & Amounts |
| 1. $ |
| 2. $ |
| 3. $ |
| 4. $ |
| 5. $ |
| 6. $ |
|
 |
|
|
EVALUATION FORM