Form | Crediva

First name

Surname

E-mail

Phone 1

Phone 2

Address (Civic number and street, ave, boul. row or road. Apartment or unit)

City of residence in Quebec

Province of Quebec

Postal Code

Desired microloan amount

Desired repayment period (in weeks)

Approximate monthly income (before taxes)

Main source of income

• Employee

• Self-employed worker

• Government benefits

• Other

Revenue frequency

Next pay date

Month

Day

Year

Do you have any significant financial obligations to mention? (e.g., other loans, pensions, special agreements)

PRIORITY PROCESSING: Same-day submission if form, documents, and contract signature are received before 10:30 a.m.

Yes

No

DECLARATIONS AND CONSENT (MANDATORY)

I confirm that the information provided in this form is accurate, complete and truthful.

(Checkbox – required)

I agree to be contacted by Crédiva regarding my microloan application.

I understand that this request does not constitute automatic approval and that no contract is concluded at this stage.

(Checkbox – required)

Yes, I agree to receive electronic communications from Crédiva. I understand that I can unsubscribe at any time.

-Receive practical advice to improve your financial situation and be informed of our solutions when they become available.

This form is solely for submitting a microloan application. Please take a moment to review the eligibility criteria before completing the form.

Submitting this form does not constitute an offer of credit or automatic approval. Each application is analyzed responsibly and confidentially, in accordance with applicable Quebec laws.