Credit application

Partner store

Are you making this request when making a purchase at a partner store? *

Yes
No

You submit this application as : *

Alone
Whit a spouse

Description of the good or service you wish to finance *

Loan Amount *

Borrower information

Name *

Prénom

Nom

Date of Birth *

Address *

Adresse ligne 1

Ville

État / Province / Région

Code postal

Telephone number *

Email

Financial situation

Type of income *

Employee
Self-employed
Retirement
Other

Gross income *

Per year
Per month
At the fortnight
Per week

Residence *

Tenant
Homeowner

Do you wish to declare additional income or assets? (Not required)

Yes
No

Have you ever filed for bankruptcy or a consumer proposal? *

No
Yes

Identity confirmation

Type of ID *

Number *

Expiration date *

Authorization to view your credit history

Social Insurance Number *

(required to consult your credit report)

Declaration and consent

I certify that the above information, which will be used to review my file, is true. I hereby authorize any banking institution and/or merchant, as well as their employees, agents, or representatives, to conduct a credit check on me and to verify my employment history. I also agree to the use, to the extent permitted by law, of the information contained in my credit file and to use it as a credit history. I acknowledge that I have been given the opportunity to review this consent before giving my agreement.

Additional information

N'hésitez pas à nous joindre

Téléphone

Rimouski : (418) 722-4371
Mont-Joli : (418) 775-4371
Amqui :(418) 629-2091

Courriel

info@mafinanciere.com

Credit application

Partner store

Borrower information

Informations of Primary borrower

Financial situation

Identity confirmation

Authorization to view your credit history

Co-borrower information

Financial situation (co-borrower)

Confirmation of identity (co-borrower)

Authorization to view your credit history (co-borrower)

N'hésitez pas à nous joindre

Téléphone

Courriel