Application for the Secured Visa® Credit Card
please fill out and print the following form,
including your cheque or money order, and mail it to:
Home Trust Company
 P.O. Box 336,
Station "A"
Etobicoke, ON   M9C 4V3

 

 TELL US ABOUT YOURSELF
First Name Initial Last Name
Address # Street Name Apartment #
City/Town Province/Territory Postal Code
Do you Currently... Rent? Own? Live with Parents? Other
Number of Years There: Months
Home Phone  Cell Phone #
E-mail Address
Social Insurance Number (mandatory**)
Mother's Maiden Name
Date of Birth (mm/dd/yy) / / Must be age of majority in your province.

 SOURCE OF INCOME
Yearly Income $ Source of Income
Current Employer Name (if employed)
Occupation
Employer's Telephone # # of years there

 DO YOU REQUIRE A SECONDARY CARD?
 TELL US ABOUT THE CO-APPLICANT
First Name Initial Last Name
Address # Street Name Apartment #
City Province Postal Code
Home Phone  Cell Phone #
Social InsuranceNumber (optional)
Current Employer Name
Occupation Income $
Employer's Telephone # # of years there

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 and 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 creditworthiness, 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 applications 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 co-applicant, 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 withdrawing 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 on the anniversary of the opening of the Security Deposit Account. Interest rates for 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 $6 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 $25, which will be billed on your first statement. There is an overlimit 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 $500. Deposit maximum is $5,000. ** My Social Insurance Number is required on this application for tax reporting purposes on the interest from my Security Deposit account.

signature of applicant ___________________________date__________


signature of co-applicant ________________________date__________

Cheque or money order amount (minimum $500) $_______________

Cheque or money order enclosed
(make cheque or money order payable to Home Trust Visa®)

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