Personal informations
First name
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Last name
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Gender
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Male
Female
Other
Email address
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Birth date
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Phone number
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Clinic
Clinic
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Patient Number
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Loan informations
Term length
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3 Months
6 Months
12 Months
24 Months
36 Months
Debit day
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1st
15th
Invoice amount
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Bank
Bank of Montreal (001)
Scotiabank (002)
RBC Royal Bank (003)
Toronto-Dominion Bank (004)
National Bank (006)
CIBC Bank (010)
HSBC Bank (016)
Canadian Western Bank (030)
Laurentian Bank of Canada (039)
Alberta Treasury Branch (219)
First National Bank (310)
PC Financial (320)
Manulife Bank (540)
Peace Hills Trust (568)
Tangerine Bank (614)
KOHO Bank (621)
Credit Union British Columbia (809)
Desjardins Quebec (815)
Credit Union Ontario (828)
Desjardins Ontario (829)
Credit Union Meridian (837)
Credit Union Heritage Brunswick (839)
Brunswick Credit Union (849)
Credit Union Manitoba (879)
Credit Union Alberta (899)
Other
Other Banks
Transit number
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