Please note that purchases must be made with participating merchants that are members of Caisse Alliance.
First Name*
Last Name*
Phone*
Email*
Branch Location*AlbanArgyleBonfieldFauquierFieldHearstIroquois FallsKapuskasingLonglacMarkstayMattawaMatticeMoonbeamNoëlvilleNorth BayOpasatikaSmooth Rock FallsSt-CharlesSturgeon FallsTimminsVal GagnéVal RitaVernerWarrenWest Ferris
Approximate total household income*
Desired loan amount (maximum $2,000 per member)*
You are a*MemberNon-member Where did you hear about this promotion?*Internet searchFacebook/InstagramRadioSpotifyWebsiteEmail newsletterWord of mouthIn a branch locationOther Comments
Caisse Alliance is authorized to use the information provided in this form to review the financing application.
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