Purchase Client Intake Sheet Step 1 of 5 20% PURCHASE RETAINERBy completing and returning this document, I/we acknowledge having retained the services of Hébert & Roy to complete our Purchase transaction and I/we give permission to the firm to commence work on my/our file.YesNoName First Last Date Name First Last Date Are you also selling a property?YesNoIf yes, when is the closing date? Are we acting for you on the sale of your property?YesNoIf your sale is closing after your purchase, are you obtaining a bridge loan?YesNoI/we have dealt with your office in the past for (list type of service and date of service):I/we was/were referred by:Name of real estate agent, if applicable:Name of mortgage brokers, if applicable: 1st ApplicantFULL LEGAL NAME First Middle Last Date of birth:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Marital statusSingleMarried*Common LawSeparatedDivorcedWidowed*Common law spouses are defined as couples that have been living together in a conjugal relationship for three years or couples that are living together in a conjugal relationship and raising a child of whom both are natural or adoptive parents.Name of spouse (if married):If separated, indicate date of separation:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920GenderMaleFemaleFirst time home buyer ?YesNoCanadian CitizenYesNoSpecial instructions/comments:Home:Work:Cell/pager:Email address: Enter Email Confirm Email Employer/ address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code OccupationWill you be residing in the property being purchased?YesNoDo you own the property(ies) adjacent/next to the property being purchased?YesNo2nd ApplicantFULL LEGAL NAME First Middle Last Date of birth:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Marital statusSingleMarried*Common LawSeparatedDivorcedWidowed*Common law spouses are defined as couples that have been living together in a conjugal relationship for three years or couples that are living together in a conjugal relationship and raising a child of whom both are natural or adoptive parents.Name of spouse (if married):If separated, indicate date of separation:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920GenderMaleFemaleFirst time home buyer ?YesNoCanadian CitizenYesNoSpecial instructions/comments:Home:Work:Cell/pager:Email address: Enter Email Confirm Email Employer/ address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code OccupationWill you be residing in the property being purchased?YesNoDo you own the property(ies) adjacent/next to the property being purchased?YesNo NEW LENDER/MORTGAGE INFORMATIONType of loan: Mortgage Line of Credit Bridge Loan (please select all applicable)Lender/bank name:Branch location (if applicable):Name of mortgage broker or contact person at bank:Contact information for mortgage broker or contact person at bank:FIRE INSURANCE* you need to contact your insurance company and request that they send us an Insurance BinderInsurance company/broker name:Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Contact person First Last Telephone numberEmail address Please review your information and click the previous button to go back and make any necessary charges : {all_fields}CommentsThis field is for validation purposes and should be left unchanged. 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