HOME TRUST SECURED VISA CARD APPLICATION
  1. Please fill out and print the following form,
  2. Attach your personal or personal certified cheque, money order or bank draft from a Canadian Financial Institution, and
  3. Mail it to:
    Home Trust Company, Attn: Visa Department
    145 King Street West, Suite 2300 Toronto, Ontario M5H 1J8


HOME TRUST SECURED VISA DISCLOSURE STATEMENT

This Disclosure Statement applies to the Account and each Card issued on the Account.
Annual Interest Rate The Interest Rate is in effect the day your Account is activated, and is set out on each monthly Account Statement, expressed as an annual percentage rate.

Purchases and Cash Advances: 19.99%
Interest - Free Grace Period Purchases: There will not be any interest charges on the amount of any Purchase appearing on your Account Statement for the first time if the New Balance shown on your Account Statement is paid in full by the Due Date and all Debt shown on the Account Statement for the preceding billing period was paid by its Due Date.

Cash Advances: There is no interest-free period on Cash Advances.
Minimum Payment 3% or $10.00

The minimum payment for the Account will be the greater of $10.00 or 3% of theNew Balance shown on your Account Statement, and any amount by which the NewBalance exceeds your Credit Limit.
Foreign Currency Conversion 2%

For Purchases or Cash Advances in a foreign currency, that foreign currency will beconverted into Canadian dollars at an exchange rate which is 2% over the exchangerate set by Visa International, in effect on the day the transaction is posted to your Account.
Monthly or Annual Fees Applicant: $5.00 monthly fee or $49.00 annual fee

Each Co-Applicant or Authorized User: $2.00 monthly fee or $19.00 annual fee

Monthly fees will be charged on your monthly Account Statement. Annual fees will be charged on the day your Account is opened and annually on the anniversary of this date.
Other Fees These are fees charged for services requested by you and will be charged on the day the transaction occurs:

ATM Charge: 1% of amount withdrawn (Minimum fee of $2.50 and Maximum fee of $10.00) for a Cash Advance from an ATM displaying the Visa or Plus logo located in Canada; 1.50% (Minimum fee of $4.50 and Maximum fee of $15.00) if the ATM is located in United States; 1.50% (Minimum fee of $5.50 and Maximum fee of $15.00) if the ATM is located outside Canada and the United States. This is in addition to any other charges that may be levied by the owner/operator of the ATM.

Dishonoured (NSF) Cheque Charge: $45.00 for each cheque or other instrumentused to pay Debt that is dishonoured by the financial institution on which it is drawn.

Statement Copy/Update Fee: $5.00 for a copy of your Account Statement for any other period other than the current statement period.

Sales/Cash Advance Draft Copy Fee: $5.00 for each copy of a Purchase or Cash Advance draft. No charge will be applied for any copy of a draft to which an Account posting error is determined.

Rush Plastic Fee: $39.00 for the delivery of a new or replacement Card by courier at your request.

Over Limit Fee: $29.00 if the Debt is permitted to exceed the Credit Limit during any period covered by an Account Statement.

Collection Fees: All costs we incur where a collection agency or a law firm is used to collect amounts due, including legal fees.

For current fees, visit www.hometrust.ca or call us at 1-877-727-6883.

  NOTE TO APPLICANTS:

  Bankruptcy: This product is not available to those who are currently bankrupt.
  Applicants recently discharged from bankruptcy must include their "Certificate of Discharge" with their completed application.

  Consumer Proposal: Applicants who have made a consumer proposal to creditors must provide a letter from their trustee
  stating that a proposal has been filed, accepted by creditors, and is in good standing.

PLEASE TELL US ABOUT YOURSELF
Marital status: Title:
First name: Initial: Last name:
Social insurance number:    
Date of birth (mm/dd/yyyy): / / (Must be age of majority in your province)
Mother's maiden name:
Please provide 2 Canadian Government Issued ID's (mandatory)
Primary Government Issued Photo ID:
Type of ID: ID #: Place of Issue:
Expiry Date:
Secondary Issued ID (Please attach copy):
Type of ID: ID #: Place of Issue:
Expiry Date:
CURRENT ADDRESS
Street #: Street name: Apartment #:
City: Province: Postal code:  
# of years:
Home phone: Mobile phone:

Email Address:
PREVIOUS ADDRESS (if less than 2 years)
Street #: Street name: Apartment #:
City: Province: Postal code:  
# of years:

PLEASE TELL US ABOUT YOUR EMPLOYMENT
Monthly income (before tax): $ Source of income:
Self employed    Full Time    Part Time    Seasonal    Student    Retired
Current employer name: Occupation:
Employer's address: Suite #:
City: Province: Postal Code:  
Business phone: # of years:

DO YOU REQUIRE A SECONDARY CARD? TELL US ABOUT THE CO-APPLICANT
MAXIMUM OF TWO CARDS PER ACCOUNT CAN BE ISSUED
Marital status: Title:
First name: Initial: Last name:
Social insurance number:    
Date of birth (mm/dd/yyyy): / / (Must be age of majority in your province)
Mother's maiden name:
Home phone: Mobile phone:
Please provide 2 Canadian Government Issued ID's (mandatory)
Primary Government Issued Photo ID:
Type of ID: ID #: Place of Issue:
Expiry Date:
Secondary Issued ID (Please attach copy):
Type of ID: ID #: Place of Issue:
Expiry Date:
ENTER THE CO-APPLICANT ADDRESS IF DIFFERENT FROM THE APPLICANT
Street #: Street name: Apartment #:
City: Province: Postal code:  
# of years:
Home phone: Mobile phone:
Email Address:
PREVIOUS ADDRESS (if less than 2 years)
Street #: Street name: Apartment #:
City: Province: Postal code:  
# of years:

PLEASE TELL US THE CO-APPLICANT'S EMPLOYMENT
Monthly income (before tax): $ Source of income:
Self employed    Full Time    Part Time    Seasonal    Student    Retired
Current employer name: Occupation:
Employer's address: Suite #:
City: Province: Postal Code:  
Business phone: # of years:

CHOOSE YOUR FEE OPTION (select one):
     Monthly fees of $5.00 for the Applicant and $2.00 for each co-Applicant or Authorized User
                    OR
     Annual fees of $49.00 for the Applicant and $19.00 for each co-Applicant or Authorized User.

I certify the above information is correct and I consent to collection and use of credit and personal information as set out below. Please read the terms and disclosures included with this application. By signing this application you agree to these terms.
Co-Applicant Disclosure: Where there is a Co-Applicant on this Account, you will each receive in separate envelopes monthly AccountStatements, disclosure statements, agreements and notices (together called “Statements” in this paragraph) at the address you set out inthis application or other address you provide to us, unless you consent to have one copy sent to one address only.

You may choose to receive only one copy of Statements by initialling the box below:

Initial   I consent to one copy of Statements being sent to us at the address set out in this Application
Initial   or such new address as we at a later time may give to you.

You may by notice to us at a later time alter this consent to have Statements sent to each Co-Applicant at the address they provide.You may contact us for further information regarding this matter at 1-877-727-6883
Initial   I/We the undersigned hereby declare that I/We are not acting on behalf of a third party and that the account
Initial   referred to here in does not have any beneficial owners.

Personal Information: You may collect credit, identity and financially related information about me during the course of my relationship with you from credit bureau, other financial institutions, references, and by contacting me ("Information"). You may also disclose Information to credit bureau, financial institutions, Visa Canada and Visa International and their agents and to outside providers of card services. You and those parties may use Information to identify me, understand my needs and eligibility for this application and for card and other services and to recommend and market particular products and services.

Information collected will be kept in a separate customer file managed by Home Trust Company at its offices in Toronto, Ontario. I have aright to access this Information. I may obtain your privacy code, ask you to correct Information, or tell you to stop using Information forany of these purposes at any time by calling you toll free at 1-866-817-7719 or by sending a written request to 145 King Street West, Suite 2300, Toronto, Ontario, M5H 1J8.

Card Account: Please open a Home Trust Visa Account in my name ("Account"), issue me card(s), and Personal IdentificationNumber(s). I will be bound by the Cardholder Agreement you will send me, as amended or replaced from time to time; use of any card applied for will prove I have received and read it. I will ensure that all Co-Applicants and authorized users review the CardholderAgreement, other agreements and program terms you will send me. Credit will be extended upon approval of this application.

Co-Applicants: The terms of the Application and all consents given in it bind each Co-Applicant. All references to "I" mean theApplicant and Co-Applicant individually. The Applicant and Co-Applicant are jointly and severally liable for all any indebtedness on theAccount incurred through the use of the cards and otherwise.

Please note that the Home Trust Secured Visa Card is not available to residents of the province of Québec.

I apply for the Home Trust Visa Account and agree to the terms and disclosures included with this application.

Signature __________________________________  Date (mm/dd/yyyy) / /

Co-applicant Signature ________________________ Date (mm/dd/yyyy) / /

Cheque amount $ (Minimum $500; Maximum $10,000)
(Personal or Personal Certified cheque, Money Order or Bank Draft from a Canadian Financial Institution)
All funds must be made payable to Home Trust Company (no cash please).

* Visa Int./Home Trust Company, licensed user of mark.




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