1. Company Information



What provinces can you do business in?

2. Principal / Owner Information


3. Product & Sales Information

Please tell us about your Merchants:

Sales Approach of Merchant Network (check all that apply)

Lead Generation Methods of Merchant/Dealer Network (Check all that apply)

Are you currently with a Finance Provider?

Products for Financing Programs

Reason for interest with CLEAR

4. Consent

5. Acknowledgement

By executing below, the Principal in his or her personal capacity (“I”, “me”) and the company (“We”) certify that all the information contained in this Broker Application is true and complete.

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