Application Form

This is the application form for RapidLoan.ca

Name(Required)

First Last

Social Insurance Number (SIN)(Required)

Date of Birth(Required)

Phone

Email(Required)

Enter Email Confirm Email

Address(Required)

Address City Province Postal Code

Financial Information

I want to borrow ($)(Required)

The amount you would like to borrow.

Please enter a number from 0 to 10000.

Gross Monthly Income

Your monthly income before taxes.

Please enter a number from 0 to 10000.

Net Monthly Income(Required)

Your monthly income after taxes.

Please enter a number from 0 to 10000.

Source of income(Required)

Employer Name(Required)

Name of your employer or source of income

Additional Information

Are you over 18 years old?(Required)

Are you currently in a non discharged bankruptcy?(Required)

Are you currently in the process of resolving bankruptcy procedings?

Have you ever taken a consumer proposal?(Required)

Have you ever had an agreement with a legal creditor to pay back less than the full amount owed?

Have you ever defaulted on a payday loan and not paid it back?(Required)

Personal Reference

Name(Required)

First Last

Phone(Required)

Relationship(Required)

Authorization

I certify the information contained in this application is true to the best of my knowledge. I also allow RapidLoan.ca to verify this information by running a credit check. I also understand that this information may be shared with select partners such as banks, credit unions or other loan providers, with the goal of providing you a loan.

I agree to the above statement(Required)

Disagree

Agree

Proof of Income (optional)

Note: Proof of income is optional for the initial application but may required for the approval of the loan.

File

Max. file size: 5 MB.

Referral

If somebody referred you to RapidLoan.ca, enter their e-mail here

Referral Email

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