Cash Back Visa^* Card Credit Application

Terms & Conditions

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Consent can be withdrawn at any time by contacting Collabria.
Phone: 1.855.341.4643
Mail: Suite 450, 110-9th Ave SW, Calgary, AB T2P 0T1
Email: info@collabriafinancial.com

I consent to receiving promotional emails from Collabria Financial Services Inc.

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Important information

Please use the scroll bar on the right to view the entire Terms and Conditions. If you are unable to view the following Terms and Conditions, please click here.

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Declaration

• Everything I will state in my application is true and correct.
• My personal credit history is clear of bankruptcies within the past 36 months.
• I have read and agree to all the pricing and other terms in the Terms and Conditions. 
• The terms of my account are subject to change.
• I consent to the collection of device-identifying data by a trusted partner.
• I acknowledge that any owner of the account, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the account, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

Tell Us About Yourself

Let's get to know each other

Please enter your full legal name (as it appears on your driver’s license or passport, for example).

First Name

Middle Initial

Last Name

What is your Social Insurance Number? (optional)

Your SIN helps us confirm your identity and process your application faster.

Social Insurance Number (SIN)

What is your date of birth?

Birthday  

What is your gender?

Gender -- Select -- Male Female Prefer Not to Answer

What is your mother's maiden name?

Mother's Maiden Name  

What is your email address?

We'll email you once your account is open.

Email Address  

Where can we reach you?

Phone Number

Member Number

Member Number

Residence

Where do you live?

Address 1  

Address 2 / Unit Number  

City

Province -- Select a Province -- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Saskatchewan Yukon  

Postal Code  

Country  

How long have you lived at your present address?

Years

Months

What is your residence status?

Residence Status -- None -- Lives With Parents Owns Rents Other

What is your monthly housing payment?

$Monthly Housing Payment  

Employment Information

Tell us about your employment

Employment Status -- Select -- Employed Retired Self Employed Unemployed Student

Occupation

Income Source

Employer  

What is your field of employment?

Employment Field -- Select -- Administration and management Agriculture, forestry, fishing and mining Labour, manufacturing Professional or technical occupation Services and entertainment Transportation and communication Office work Specialized manual labour or craft Sales

Position

What is your level of study?

Level of Study -- Select -- Post-Secondary Secondary

Field of Study

What is your work phone number?

Work Phone

How long have you worked at your present place of employment?

Years

Months

What is your monthly gross income?

$Monthly Gross Income  

How long have you been unemployed?

Years

Months

Additional Information

Promotional Code

Promotional Code

Referred By

Referred By

Intended use of the credit card

Intended use -- Select -- Manage personal expenses Manage household expenses Manage personal and household expenses Manage personal/household and business expenses Manage self-employment expenses Manage business/organizational expenses and transactions

Are you an employee of the financial institution?

Yes No

Would you like to add an additional user and apply for joint credit?

Yes No  

What is their name?

Please enter their full legal name (as it appears on their driver’s license or passport, for example).

First Name

Middle Initial

Last Name

Date of Birth

Birthday  

Mother's Maiden Name

Mother's Maiden Name

What is their gender?

Gender -- Select -- Male Female Prefer Not to Answer

Are you an employee of the financial institution?

Yes No

Where do they live?

Is this the same address as primary applicant?.

Address 1  

Address 2 / Unit Number  

City

Province -- Select a Province -- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Saskatchewan Yukon  

Postal Code  

Country  

How long have they lived at your present address?

Years

Months

What is their residence status?

Residence Status -- None -- Lives With Parents Owns Rents Other

What is their monthly housing payment?

$Monthly Housing Payment  

What is their email address?

Email Address  

Where can we reach them?

Phone Number

Member Number

Member Number

Tell us about their employment

Employment Status -- Select -- Employed Retired Self Employed Unemployed Student

Occupation

Employer  

What is their field of employment?

Employment Field -- Select -- Administration and management Agriculture, forestry, fishing and mining Labour, manufacturing Professional or technical occupation Services and entertainment Transportation and communication Office work Specialized manual labour or craft Sales

Position

What is their level of study?

Level of Study -- Select -- Post-Secondary Secondary

Field of Study

How long have they worked at your present place of employment?

Years

Months

What is their monthly gross income?

$Monthly Gross Income  

How long have they been unemployed?

Years

Months

Note: By adding a co-applicant, each applicant will have the right to use the account to the extent of the credit limit on the account and will be liable for all credit extended under the account to any co-applicant.

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Would you like to add an authorized user?

Yes No

What is their name?

Please enter their full legal name (as it appears on their driver’s license or passport, for example).

First Name

Middle Initial

Last Name

When is their birthday?

Birthday  

What is their country?

Country  

What is their gender?

Gender -- Select -- -- Select -- Male Female Prefer Not to Answer

Be prepared for the what ifs in life

I am interested in learning more about Balance Protection Insurance

Yes No