Applying For

Lease/Finance
Working Capital
Both

Step 1: Company Information
Step 2: Customer Information
Step 3: Equipment Information

Step 1: Company Information
- New Company
- Existing Company

Legal Company Name *
Operating Name (DBA) *
Business Type *
In Business Since * *
Physical Address *
City *
Province *
Postal Code * *
Province of Incorporation *
Business Phone * * Ext.
Business Fax *
Email Address * *
Website *
Average Annual Revenue * *
Average Bank Balance * *

Step 2: Customer Information
Principal 1
- - New Contact
  - Existing Contact
- First Name *
- Last Name *
- Job Title *
- Percent of Ownership * * *
- Same as Business Addr.?
  - Yes
  - No
- Home Address *
- City *
- Province *
- Postal Code * *
- Mobile Phone * *
- Email Address * *
- Social Insurance Number * *
- Date of Birth * *
- Home Ownership *
  - Own
  - Rent
- Value of Home * *
- Mortgage Balance * *
- Ever Declared Bankruptcy? *
  - No
  - Yes
- Outstanding Judgements or Legal Proceedings? *
  - No
  - Yes
Principal 2
- - New Contact
  - Existing Contact
- First Name *
- Last Name *
- Job Title *
- Percent of Ownership * * *
- Same as Business Addr.?
  - Yes
  - No
- Home Address *
- City *
- Province *
- Postal Code * *
- Mobile Phone * *
- Email Address * *
- Social Insurance Number * *
- Date of Birth * *
- Home Ownership *
  - Own
  - Rent
- Value of Home * *
- Mortgage Balance * *
- Ever Declared Bankruptcy? *
  - No
  - Yes
- Outstanding Judgements or Legal Proceedings? *
  - No
  - Yes
Principal 3
- - New Contact
  - Existing Contact
- First Name *
- Last Name *
- Job Title *
- Percent of Ownership * * *
- Same as Business Addr.?
  - Yes
  - No
- Home Address *
- City *
- Province *
- Postal Code * *
- Mobile Phone * *
- Email Address * *
- Social Insurance Number * *
- Date of Birth * *
- Home Ownership *
  - Own
  - Rent
- Value of Home * *
- Mortgage Balance * *
- Ever Declared Bankruptcy? *
  - No
  - Yes
- Outstanding Judgements or Legal Proceedings? *
  - No
  - Yes
Principal 4
- - New Contact
  - Existing Contact
- First Name *
- Last Name *
- Job Title *
- Percent of Ownership * * *
- Same as Business Addr.?
  - Yes
  - No
- Home Address *
- City *
- Province *
- Postal Code * *
- Mobile Phone * *
- Email Address * *
- Social Insurance Number * *
- Date of Birth * *
- Home Ownership *
  - Own
  - Rent
- Value of Home * *
- Mortgage Balance * *
- Ever Declared Bankruptcy? *
  - No
  - Yes
- Outstanding Judgements or Legal Proceedings? *
  - No
  - Yes
Principal 5
- - New Contact
  - Existing Contact
- First Name *
- Last Name *
- Job Title *
- Percent of Ownership * * *
- Same as Business Addr.?
  - Yes
  - No
- Home Address *
- City *
- Province *
- Postal Code * *
- Mobile Phone * *
- Email Address * *
- Social Insurance Number * *
- Date of Birth * *
- Home Ownership *
  - Own
  - Rent
- Value of Home * *
- Mortgage Balance * *
- Ever Declared Bankruptcy? *
  - No
  - Yes
- Outstanding Judgements or Legal Proceedings? *
  - No
  - Yes
Principal 6
- - New Contact
  - Existing Contact
- First Name *
- Last Name *
- Job Title *
- Percent of Ownership * * *
- Same as Business Addr.?
  - Yes
  - No
- Home Address *
- City *
- Province *
- Postal Code * *
- Mobile Phone * *
- Email Address * *
- Social Insurance Number * *
- Date of Birth * *
- Home Ownership *
  - Own
  - Rent
- Value of Home * *
- Mortgage Balance * *
- Ever Declared Bankruptcy? *
  - No
  - Yes
- Outstanding Judgements or Legal Proceedings? *
  - No
  - Yes

Step 3: Equipment Information
Equipment Description *
Vendor Company Name *
Vendor Contact Name *
Vendor Contact Number * *
Estimated Equipment Cost * *
Equipment Status *
- New
- Used
Equipment Titled *
- Yes
- No
Equipment Year * *
Working Capital Amount * *
Budgeted Monthly Payment * *
Time Frame *
Preferred Term (months) * *
Reason for Equipment Acquisition *
Comments *
Please note that you will be able to upload any attachments you wish to include after the initial submission.
By checking this box, I agree with the Terms of Use and Privacy Policy. *
Each party to this application agrees that Patron West may review his or her personal credit profile from a national credit bureau provider. *

Processing...

Thank you for submitting your application. We look forward to working with you. Please expect a sales executive to contact you shortly.
Lease Reference Number:
Working Capital Reference Number:
Attachments
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For questions about financing, contact: Michel Laframboise Phone: 888-435-4171 x222 Email: michel@patronwest.com

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April 24, 2024