Client Intake Form
1st Client Name
*
First Name
Last Name
Occupation
*
Occupation Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth 1st party
*
-
Month
-
Day
Year
Date Picker Icon
Marital Status
*
Married to each other
Single
Separated
3 years or more living together
Citizenship/Residency
*
Canadian Citizen
Permanent Resident Status
Non- Resident
Other
Have you ever owned a home anywhere in the world previously?
*
Yes
No
Refinance, Not Applicable
2nd Client Name
First Name
Last Name
Occupation
Occupation Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth 2nd party
-
Month
-
Day
Year
Date Picker Icon
Citizenship/Residency
Canadian Citizen
Permanent Resident Status
Non- Resident
Other
Have you ever owned a home anywhere in the world previously?
Yes
No
Refinance, Not Applicable
Marital Status
Married to each other
Single
Separated
Common Law 3
Closing Date
*
-
Month
-
Day
Year
Date Picker Icon
Type of Dwelling?
Detached
Semi-detached
Condominium
Cottage
Vacant Lot
Current Intended Use of Property
*
I/we will be occupying as our Primary Residence
Family Member will be occupying as Prim Res.
Part Owner Occupied, Part Rented
Wholly Rented
Will you be doing Property Improvements in the Future?
*
No Changes
Possible Extension/addition to home
Possible Fence Installation
Possible Pool or other unattached structure
Is the property to be held in a Corporation name?
*
Yes
No
Will Someone Else have an Interest in the property as Trustee, Nominee or other capacity?
*
Yes
No
Unsure
Address of Home being Purchased, if applicable
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
E-mail
*
Name of Banker / Mortgage Broker
Name of Local Insurance Broker/provider
Submit
Should be Empty: