CashFlow Magnate

Client Information Form

Affiliate ID#

Affiliate Name

CONFIDENTIAL

Affiliate TD#

Reference:

Date (mm/dd/yy)

Affiliate Cellular#

Affiliate Email

Client Surname, FirstName, Initials

Date of Birth (mm/dd/yy)

S.I.N.

Spouse Surname, FirstName, Initials

Date of Birth (mm/dd/yy)

S.I.N.

Affiliate Business#

Affiliate Residence#

Affiliate Fax#

Present Address (if < 3yrs provide previous address on back)

City

Prov

Postal Code

Residence#

Business#

Fax#

Combined RRSP $ Value

Cellular#

Email

[ ] Owned [ ] Rented
Previous Address (if < 3yrs at present address)

[ ] Owned [ ] Rented

City

Province

Postal Code

List of ALL Existing Debts

Name of Creditor

Balance Owing

Interest

Actual Payment

(Use reverse side if more space required)

Minimum
Monthly Payment

Income & Employment Information

Client Employer Name

Title/Occupation

Years/mths

Employer Address

Annual Gross Income $

Client Previous Employer (if present < 3yrs)

Title/Occupation

Years/mths

Employer Address

Annual Gross Income $

Spouse Employer Name

Title/Occupation

Years/mths

Employer Address

Annual Gross Income $

Spouse Previous Employer (if present < 3yrs)

Title/Occupation

Years/mths

Employer Address

Annual Gross Income $

Other Income 1

Other Income 2

Property Description:

[ ] House

[ ] Condominium [ ] Other:

Other Income 3

CURRENT MARKET VALUE: $

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CashFlow Magnate
Year Built

Storeys

Client Information Form

# BedroomsHome Sqft.

Lot size

Mortgage Information:

[ For Homeowners Only]

Name of 1st Mortgage Holder

Mortgage #

Orig. Purch. DateMtge Start Date

Interest Rate

Name of 2nd Mortgage Holder (if applic.)

Mortgage #

Mtge Start Date

Mortgage Type

Interest Rate

CONFIDENTIAL

Garage Type

Heating Type

Original Mtge Balance $

Owner Occupied?Condo Fees (if applic.)

Current Mtge Balance $

Mortgage Type: Open / Closed

Maturity Date (mm/dd/yy)

Original Mtge Balance $

Maturity Date (mm/dd/yy)

Monthly P+ I Payment

Property Tax $

Incl. in Mtge Payt?

Current Mtge Balance

Monthly P+ I Payment

Appraisal Date (if applicable)

Appraised Value $

0.00%
Credit History:
Check One:

Excellent

Have you ever filed bankruptcy? [ ] Yes

Good

Poor

Fair

[ ] No

If Yes, discharge date:

Other Information:

Client Consent:
I/We understand that I/We have applied for a debt management analysis /report(s)
Each debt analysis must be complete and accurate for processing. Turn around time to review summary report with associate is 5-7 business days from date of receipt of a completed CIF
by the company. _________(INITIAL)
I/We understand that Company or their assigned is authorized to obtain credit information from credit bureau for verification of information. _________(INITIAL)
Upon review, acceptance and verification of CFM fee paid (if applicable), Company will release the FULL REPORT WITH SCHEDULES _________(INITIAL)
Must be completed to give us permission to go forward with the review

Client Signature

Date(mm/dd/yy)

Spouse Signature

Date(mm/dd/yy)

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