Application Form

Vehicle on our website, you are interested in?

Full Names

Surname

Id Number

Cellphone Number

Residential Address

Married Married Yes No

Married In Community Married In Community Yes No

Years at Address

Work Address

Work number (landline)

Salary after deductions (nett)

Where do you bank?

Basic Salary before deductions (gross)

Bank account number

Type of account

MONTHLY EXPENSES: Bond payment

Rent

Name of Employer

Vehicle Instalment (excl. instalments to be settled)

Personal Loan Repayments

Credit Card Repayments

Furniture account/Clothing account repayments

Relative name & surname

Relative Residential Address

Relation

Tel No

Do you want to trade in?

Rates / Water & Electricity

Current km

Transport Costs

Make

Bank where vehicle is financed?

Finance account number

Settlement amount (if known)

I hereby consent to the Credit Provider accessing my credit profile from the credit bureaus for the purposes of a credit assessment. I hereby consent to the Credit Provider accessing my credit profile from the credit bureaus for the purposes of a credit assessment. Yes No