PhoneVEHICLE FINANCE APPLICATIONVehicle Details Make Model Year M&M Code Price Finance Details Deposit Term Preferred Bank Residual Value Expected Installment CUSTOMER DETAILS Title Choose One Mr. Ms. Mrs. Prof. Dr. First Name * Middle Name Surname * ID Number * Marital Status * Date Married COP/ANC Residential Address * Suburb / Area * City / Town * Renting * YES NO Bonded * YES NO Period at Home * Email Address * Home Number Work Number Cell Number * EMPLOYMENT DETAILS Company Name Company Address Period Employed Employment Title RELATIVES DETAILS Name and Surname * Contact Number * Relation * Residential Address * Surburb / Area * City / Town * BANKING DETAILS Bank Name * Account Number * Account Type * INCOME AND EXPENSES GROSS SALARY * TRAVEL ALLOWANCE PETROL ALLOWANCE OVERTIME COMMISSION NET SALARY BOND / RENT VEHICLE INSTALLMENT TELEPHONE POLICY INSURANCE CLOTHING FURNITURE CREDIT CARD PERSONAL LOAN HOUSEHOLD EXPENSE TRANSPORT AND PETROL OTHER EXPENSES total incone and expenses Total: I hereby grant the Credit Provider the right to communicate through any electronic/written media or verbally in order to make available to me, their product offerng and to utilise my information for supporting products as communicated by one of the Credit Provider Partners YES NO I authorise the Credit Provide to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process this application. YES NO Information Summary Have any question ? +27 (0) 21 696 9344
