My variable credit application

×Please note that we strictly accept new application from the province of Québec.

Personal information

First name*

Last name*

Date of birth*

Cell phone*

Home phone*

Email*

Gender*

Man

Woman

Social insurance number*

Address

Address*

Apt.

City*

Province*

Postal code*

Job

Source of income*

Name of employer*

Employer phone number*

Ext.*

Job description*

Name of supervisor*

Approximate date of hiring*

Bank

Your bank*

Are you planning on declaring bankruptcy, consumer proposal or volontary deposit in the future?*

Yes

Did you declare bankruptcy, consumer proposal or volontary deposit in the past?*

Yes

Credit margin information

Amount of the credit margin*

Pay Frequency*

Next pay date*

Contact information

We are not going to call this contact in the process of obtaining this credit margin. We need it on file in case of default and breach of communication.

First name*

Last name*

Phone number*

Your relationship*

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By submitting this form, I hereby confirm that all information provided are up to date and exact, and that I have fully read and accepted the overall terms and conditions. I also authorize superpret.ca to contact me periodically by email about updates on my credit margin or for promotion purposes.