EQUAL PAYMENT AGREEMENTEqual Payment Agreement • August 13th, 2013
REFERENCE #: MAX APPROVED AMOUNT: $ 1 | APPLICANT INFORMATION (REGISTERED OWNER OF PREMISES) Last Name: First Name: Middle Initial: Date of Birth (MM-DD-YYYY): S.I.N. # (Optional): Street Address: Unit #: City: Province: Postal Code: Home Tel: ( ) Length at Residence: Months Years Own Rent Monthly Pmt. $ Driver’s License #: Credit Card # (Optional): Marital Status: Married Single Divorced/Separated Widowed Common Law Annual Household Income (Required for amounts $7,500 or greater): $ Employment Status: Employed Self-Employed Unemployed Retired Other Length of Employment: Months Years Employer Name: Job Title: Business Tel: ( ) Email (Optional):
