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First name:
Last name:
Gender:  F   M
Marital status:
Brith date:
Social Security number:
Email:
Telephone number:
Cell number:
Address:
City:
Province:
Postal code:
You have lived here since:
At this address you are:  Tenant   Owner
Rent:
Market value:
Mortgage value:
Mortgage holder :
Employer:
Job:
Employer's telephone:
Monthly salary:
Employement time:
Previous job:
What is your budget?
Have you ever filed for
bankruptcy?
 Yes   No
Cosigned?  Yes   No
Authorization for
credit check?
 Yes   No


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