Financing request

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    Nb) All fields are mandatory.

Date:    Amount of Loan:    Reason for request:

Personal information

Gender: Female Male Maritial Status: Divorced Married Common Law Widow/Widower Separated Single Name: First name: Current address: App #: City: Province: Postal code:         Email :            Home phone: Cellular phone: Owner or Tenant: ------------Make your choice------------ Owner Tenant How long at this address: ------------Make your choice------------ 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years More than 12 years Address if less than 2 years old : How long at this address: ------------Make your choice------------ 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years More than 12 years Month(s): Amount of rent or mortgage: Monthly Payment: Mortage Holder or Landlord: Birth Date: Social insurance #: Driving license #:     Expiry:  Gross Income annual ($):     Other Income: $ Gross     Investments ($):  REER ($):     Other residences or buildings ($): Name of your bank     How long account is open ?

Have you ever declared bankruptcy ? Yes No     Voluntary deposit ? Yes No     Consumer proposal Yes No If yes, what year ?    Are you released ? Yes No     Are you currently in recovery ? Yes No Do you have to pay child support Yes No     If so how much ?

Employer reference

Company you work for now: Name of the company:     Address:     Telephone: How long have you been employed at this location ?     Position : Status ? : Make your choice Full Time Full Time(Probation) Part Time(Casual) Part Time(Regular) Retired Seasonal Summer Seasonal Winter Self Employed Are you paid by check or direct deposit ? : ------------Make your choice------------ Check Dépôt direct Other If less than 2 years Name of the company:     Address:     Telephone: How long have you been employed at this location ?   Position : Status ? : Make your choice Full Time Full Time(Probation) Part Time(Casual) Part Time(Regular) Retired Seasonal Summer Seasonal Winter Self Employed

I authorize MG Performance to conduct a credit investigation to me and I agree to what you furnish and that you exchange personal information or credit for me (including my social insurance number). Without limiting the content of these, I agree that all credit reporting agencies, financial institutions or other person or entity with whom I have or I propose to have a financial relationship, you furnish personal information or credit that you exchange of such information with them.
I authorize MG Performance to use the personal information or credit necessary for the transaction. This consent is valid for the time necessary to complete the transaction.

Yes I agree
No I refuse

      

VERY IMPORTANT

With this form you must send a copy of your vehicle registration and a copy of your driver's license by email or fax to : 450-778-2387.

For a loan application by fax, click here. (printable PDF file)

MG Performance

851, Rue Principale (Route 137)
St-Dominique, Qc.
(Canada)J0H 1L0
Tél: 450-778-2453
Fax: 450-778-2387