Online Loan Request Form

Please input your desired loan:
Loanmanagement -- dbo.Countries
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Country of Residence
Where do you work? In case you have a pension. Please specify the source.
How many people work there?
How long have you been working at your employer? Please specify in months.
Do you want your employer to retain your payment, and pay us? This will increase your chances of getting a loan!
Cedula Number
How did you find out about us?
First Names
Last Name
Company Name. Fill this field only if a company is applying for a loan.
KVK Nummer. Fill this field only if a company is applying for a loan.
Address
Cellphone 1
Cellphone 2
Home Phone
Nationality
At what Bank do you want to receive your loan deposit?
Bank Account Number
What kind of customer are you? If you work for an employer please specify: Personal.
In how many months do you want to pay the loan back?
Have you had a previous loan with us?
If you had a previous loan with us. Please fill in what you still owe us. If you don't owe us anything leave at 0
What is the amount you desire? * Note: This amount is your local currency, see next page.
Email