Financing Application Form

Important Notice:
Before completing this form, please ensure you have signed up on our website. It is crucial to use the exact first name, last name, and email address used during the sign-up process.

First Name^*

Last Name^*

Email^*

Contact Number^*

Do you agree to be contacted by H-Authentica via SMS?^*

Yes

Do you rent or own your home?^*

Rent

Own

Address^*

Selfie Holding ID^*

For your security and protection, we kindly ask you to provide a selfie holding your ID. This extra step helps us ensure that you are the rightful cardholder, safeguarding your account from unauthorized use.

Valid ID (For Canadian Residents - Canadian Issued ID's only are accepted)^*

ID Expiry^*

PAD Form or Void Cheque^*

Credit Card

CC Front Photo^*

CC Back Photo^*

Expiration^*

I have read the Privacy Policy Terms and Conditions^*