Secure Finance Application

Statement of Consent

I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience.

Please initial below to indicate that you have received a copy of our Privacy Notice and agree to all of the above.

YOUR CREDIT APPLICATION IS GOING THROUGH A SECURE WEBSITE AND YOUR IDENTITY IS SAFE

Your Contact Information

Name As It Appears on Driver's License

Company Name(inc. only)

First Name

Middle Name

Last Name

SIN

Address

City

Province

Postal Code

Phone

E-mail

Date of Birth

Current Employer

Occupation

Annual Income

Employed Since

Signature

Signature (typed):

I give consent to Kubota Canada Ltd. To check for credit for the purpose of financing equipment through Kubota Canada Ltd.