David Docksteader, MBI

By submitting this application form you warrant and confirm that the information given is true and correct and that you understand it is being sent to VERICO and David Docksteader, MBI and used for the purpose of processing your requested transaction. You also hereby consent to the use of this information by all companies listed as suppliers on www.mortgageweb.ca and that each supplier may receive a copy of the information you provide for the purposes of providing their product or services to you. Each supplier hereby confirms to you that once they are in possession of the your information the supplier shall strictly adhere to all personal information privacy protection and used for the purpose of processing your requested transaction. You also hereby consent to the use of this information by all companies listed as suppliers on www.mortgageweb.ca and that each supplier may receive a copy of the information you provide for the purposes of providing their product or services to you. Each supplier hereby confirms to you that once they are in possession of the your information the supplier shall strictly adhere to all personal information privacy protection laws in Canada.