Application for
the Home Trust Secured VISAŽ Credit Card
please fill out and print the following form,
including your cheque or money order, and mail it to:
Home Trust Company
Attn: Secured VISA
145 King Street West, Suite 1910
Toronto, Ontario
M5H 1J8
PLEASE
TELL US ABOUT YOURSELF
Social insurance number (mandatory**)
Title: Mr. Mrs.
Ms.
Miss
Dr.
First name Initial
Last name
Date of birth (mm/dd/yy)
/ / Must
be age of majority in your province.
Mother's maiden name
CURRENT ADDRESS
Street # Street name
Apartment #
City/Town Province
Postal code
#
of years there: Months
Mobile phone
Home phone
E-mail Address
MAILING ADDRESS
(if different than above )
Street # Street name
Apartment #
City/Town Province
Postal code
PREVIOUS ADDRESS
Street # Street name
Apartment #
City/Town Province
Postal code Number of years
there:
SOURCE OF
INCOME
Monthly income (before tax) $
Source of income
Self employed: Yes No
Student: Yes
No
Current employer name (if employed)
Occupation
Business phone #
# of years/months
there
IF STUDENT
PLEASE COMPLETE
Educational institution
Course of study
# of years completed
DO YOU REQUIRE A SECONDARY CARD? TELL US ABOUT THE CO-APPLICANT.
MAXIMUM OF
TWO CARDS PER ACCOUNT CAN BE ISSUED.
First name Initial
Last name Date of birth (mm/dd/yy)
/ /
Home phone
Current employer name/source of income
Business phone
Social insurance number
† I certify the above information to be true and correct
and by signing below accept as notice in writing of, and consent to, collection,
use, disclosure and verification of any credit, personal or other information
about me at any time from, to or with any credit reporting agency, credit
grantor, or any other person with whom I may have financial dealings or
as may be permitted or required by law. I authorize those parties to give
information to you. I understand that all such information shall be collected,
used and disclosed by you, and any affiliates, agents, service providers,
successors or assigns thereof to assess my creditworthiness for this application
and my on-going credit worthiness, for determining my eligibility for
any other products and services to be offered to me and for such other
uses not prohibited by law. By signing this application, I agree to abide
and be bound by the terms and conditions of the Cardholder Agreement which
Home Trust will send (as amended or restated from time to time). I agree
that you may open a Home Trust VISA account in my name ("Account"), issue
me card(s), Personal Identification Number and renewals or replacements
from time to time. I agree if I use my card or Account, I shall be deemed
to have requested and received the card, Account and Cardholder Agreement,
and that I agree with everything written in the Cardholder Agreement and
this application. Where a co-applicant signs this application, we acknowledge
the terms of this application and all consents given in it bind both of
us, and all references to "I" shall mean the applicant and co-applicant
individually. Each applicant and coapplicant, shall be jointly and severally
liable for any indebtedness incurred through the use of the cards issued
pursuant to this application. I may obtain your privacy code or review
my options for refusing or with drawing this consent, including my option
not to be contacted about offers of products or services. My Security
Deposit will be held in an interest bearing account with interest payable
to me annually. Interest rates paid on the Security Deposit are shown
on my Account Statement and are subject to change. I am required to make
regular payments of 3% of the outstanding balance or $10 (whichever is
greater) on my Account. Failure to do so will result in forfeiting the
Security Deposit up to the amount of the Debt owing.
A monthly fee of $7.50 applies, plus
$3 monthly for a co-applicant beginning with the second statement. If
approved, your account will be charged a one-time set up fee of $39, which
will be billed on your first statement. There is an over limit fee of
$29 for every month the credit limit is exceeded and an NSF payment cheque
fee of $39. Annual interest rate on unpaid balances is currently 19.50%
for purchases and 21.50% for cash advances. For Accounts in Arrears the
annual interest rate on unpaid balances is 24.50%. These rates and fees
are subject to change with notice. Deposit minimum is $1000. Deposit maximum
is $10,000. ** My Social Insurance Number is required on this application
for tax reporting purposes on the interest from my Security Deposit account.
Signature ___________________________ Date (mm/dd/yy)
/ /
Co-applicant
Signature ________________________ Date (mm/dd/yy)
/ /
Cheque or money order amount $
Cheque or
money order enclosed payable to Home Trust VISA?
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