First Name*

Last Name*

Email

Phone* (+1 868-XXX-XXXX)

Address 1*

Address 2

City*

Country*

Working adults in home*

Kids under 18*

Living status* Select… Own my home (paid in Full) Own my home (with mortgage) Renting Living with family Other

Years at current address*

Are you self employed?* Select… No Yes

How are you paid?* Select… bank cash cheque other

Place of work / Business name*

Monthly income (TTD)*

Loans/Credit card (avg. monthly)

Customer comment

References (optional)

Ref 1 Name

Ref 1 Relationship

Ref 1 Contact

Ref 2 Name

Ref 2 Relationship

Ref 2 Contact

Willing monthly installment (TTD)*

“3 Months for Cash” plan with down payment?* Select… No Yes

Which bank do you use?* Select Bank… Scotia RBC RBL First Citizen Bank JMMB Bank of Baroda CIBC

How did you hear about us?* Select… Referral Facebook Instagram TikTok Walk-in Other

Additional comment

optional upload ID, bank statement, etc (up to 6 files)

Max 10MB each. Allowed: JPG, PNG, PDF, HEIC.

I confirm the information above is accurate and I consent to credit checks.