LOAN APPLICATION FORM

1. CALL TODAY (844) 243-5060 MAIL US NOW info@cancoconsulting.com     HomeAbout UsLoan ServicesQualificationsContact UsBlogApply Now !FR APPLY NOW LOAN APPLICATION FORM LOAN DETAILS Please enter the amount of money you want to borrow You are applying for? * Secured Loan Amount * What is the reason for your loan? * Unsecured Loan Please enter the amount of money you want to borrow. Select Amount to Borrow Select Amount to borrow PERSONAL INFORMATION Please fill up your personal information below First Name * Email address * Choose your province Postal Code * Last Name * Address * YYYY-MM-DD  Phone Number * City * INFORMATION Approximate Monthly Expense * Please select Marital Status? Credit Score? Marital Status Father's Full Name * Mother's Full Name * Mother's Maiden Name * MARRIED INFORMATION Spouse Fullname * Spouse Date of Birth * Does Your Spouse Work? YYYY-MM-DD  Does Your Spouse Work? What's Your Spouse Occupation? What's your Spouse's Gross Annual salary? What’s Your Spouse Credit Score? * Spouse Employer Name * DEPENDENT(S) INFORMATION Do you have any Dependent(s)? * Please select

2. DEPENDENT(S) INFORMATION How Many Dependent(s)? * Do you receive child benefits? * What's your monthly child benefits? * Please select EMPLOYMENT Are you Currently Employed * Please select Job Sector * Please select Other Job Sector Name * Current Employer Name * Job Title * Annual Gross Income * Employer Phone Number * How long have you been working at your present work? * Complete address of the office where you're working * Select Previous Employment? Previous Employment? How long did you work at your previous work? * Previous Employer Name * Please Contact our office at (844) 243-5060 or send an email to info@cancoconsulting.com for more information. RESIDENCE INFORMATION Housing Status * Please select How long have you been living at your current address? * What is your rent per month? * How long have you been living at your current address? * What is your monthly mortgage payment? * ASSETS Are you an asset owner? * Yes No COLLATERAL IS REQUIRED FOR “SECURED LOANS" ARE YOU AN ASSET OWNER? (If you own multiple assets, you can choose more than one asset) Car Owner Home Owner Mobile Home Owner Trailer Owner Land Owner Other Jewelry Coins Gold Other Asset's Name *

3. Check which you have Your Asset(s) Info: CAR Vehicle Year Model Select Make Kilometers Value Select Vehicle Paid Out? Balance on Vehicle? When Balance Paid in Full? * Remaining balance to pay * YYYY-MM-DD -  When Balance Paid in Full? How much was your original car loan amount? * HOME Home Assessment Value Mortgage balance Mortgage balance 2 Purchase Price Date of Purchase 2016-01-01  Date of Purchase ADDITIONAL INFORMATION FOR HOME OWNER Name of Mortgage 1 Mortgage Balance 1 Interest Rate of 1st mortgage Name of Mortgage 2 Mortgage Balance 2 Interest Rate of 2nd mortgage Year it was built? Property Type Select Type Taxes Monthly Maintenance Number of Stories Year Built? 1 Elevators Management Company Select Garage/Parking Space Porch Baths Bedrooms 1 1 Condition Square Footage

4. Recent Renovation Select RENOVATION DETAILS WALLS Renovation Date Renovation Details YYYY-MM-DD  WINDOWS Renovation Date Renovation Details YYYY-MM-DD  ROOF Renovation Date Renovation Details YYYY-MM-DD  BATHROOM Renovation Date Renovation Details YYYY-MM-DD  KITCHEN Renovation Date Renovation Details YYYY-MM-DD  FLOOR Renovation Date Renovation Details YYYY-MM-DD  DECK Renovation Date Renovation Details YYYY-MM-DD  OTHER RENOVATIONS Renovation Date Renovation Details YYYY-MM-DD  MOBILE HOME Municipal value Mortgage balance Purchase price Date of Purchase * Year Make YYYY-MM-DD  Date of Purchase Model Located On Select Option Land Owner's Name Land Owner's Phone Number Land Owner's Address Mobile Home Park Name Mobile Home Park Address Mobile Home Park Phone Number Mobile Home Park Manager How many units are in the park? Municipal Value Mortgage Balance Purchase Price Date of Purchase YYYY-MM-DD  Date of Purchase TRAILER

5. Year Make Model Slides Value Trailer Paid Out Please select LAND Municipal value Mortgage balance Purchase price Date of Purchase YYYY-MM-DD  Date of Purchase Did You Apply for a Loan before? * Do You Currently have a Loan with Us? * Please select Please select How did you hear about BHM Financial? * Type the characters * Security Check Yes, I would like to receive a quote on how much CASH I can get on my Title Loan as well as information on other products and/or services from and its affiliates via text message and email. By making this selection, I understand and agree I will receive text messages at the mobile number provided. I know my selection is not necessary to apply for and/or use services. By applying I agree to Canco Consulting Wireless Policy, Privacy Policy & Terms & Conditions Submit & Continue CONTACT US Canco Consulting IMPORTANT LINKS 1090 Avenue Pratt - Suite 110. Montreal, QC H2V 2V2, Canada If you own an asset, we can help find the best possible financing to suit your needs. Whatever you need funds for - whether it’s for a home renovation or repair, vacation, new furniture or even debt consolidation we can help. Home About Us Apply Online Loan Services Qualifications Contact Us Wireless Policy Privacy Policy Terms & Conditions          info@cancoconsultin g.com       (844) 243-5060 Canco Consulting © 2017. All Right Reserved. Design & Developed By: PMSL TECHNOLOGY