MG Performance
Request Form
Puce Financing request

Secure SSL protected page (2048 bits)   SSL Certificat
    Nb) All fields are mandatory.

Date:   Arrow Amount of Loan:   Arrow Reason for request:

Puce Personal information

Female Male
Maritial Status:
Divorced Married Common Law Widow/Widower Separated Single
First name:
Current address:
App #:
Postal code:         Email :
Home phone:
Cellular phone:
Owner or Tenant:
How long at this address:
Address if less than 2 years old :
How long at this address:
Amount of rent or mortgage:
Monthly Payment:
Mortage Holder or Landlord:
Birth Date:
Social insurance #:
Driving license #:

   Flèche Expiry:
Flèche Gross Income annual ($):    Flèche Other Income: $ Gross    Flèche Investments ($):
Flèche REER ($):    Flèche Other residences or buildings ($):
Name of your bank    Flèche How long account is open ?

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

Puce Employer reference

Company you work for now:
Name of the company:    Arrow Address:    Arrow Telephone:
How long have you been employed at this location ?    Arrow Position : Status ? :
Are you paid by check or direct deposit ? :

If less than 2 years
Name of the company:    Arrow Address:    Arrow Telephone:
How long have you been employed at this location ?  Arrow Position : Status ? :

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


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 :

For a loan application by fax, click here. (printable PDF file)
Puce MG Performance
851, Rue Principale (Route 137)
St-Dominique, Qc.
(Canada)J0H 1L0
Tél: 450-778-2453
Fax: 450-778-2387