Finance Application Form


Please fill in our vehicle application form below:

Personal Information
Title: Residential Address: A value is required.
Name: A value is required.  
Surname: A value is required.  
ID Number: A value is required.  
Phone (W): A value is required. Postal Code: A value is required.
Phone (H): A value is required. Duration at current address: A value is required.
Phone (Cell):: A value is required. Postal Address: A value is require
Email Address: A value is required.  
     
    Postal Code: A value is required.
       
    Previous Address: A value is required.
     
     
     
       
    Duration at previous address: A value is required.
Employment Information
Empoyer: A value is required. Employer Physical Address: A value is required.
Type of industry: A value is required.  
Occupation: A value is required.  
Duration of current: A value is required.  
Employee number:    
Gross Salary: A value is required. Employer contact number: A value is required.
Car Allowance: Previous Employer:
Other Income:    
If other please specify:    
Reference
Relative not living with you: A value is required. Relative physical address: A value is required.
Relationship: A value is required.  
Phone (H):  
Phone (W):    
Phone (C): A value is required.    
Home Ownership Details:
Do you own a home: Please select an item.    
Is it in your name: Please select an item.    
Spouse's Information
Marital Status: A value is required. Name of employer:
Spouse Name: Gross Salary:
ID Number: Phone (W):
Date of marriage: Phone (C):
Occupation:    
Vehicle Details
Make: A value is required. Vehicle Price: A value is required.
Model: A value is required. Deposit: A value is required.
Bay Number: A value is required. M&M Code:
Household Income Details
Basic Salary: Less Tax:
Car Allowance: Less Medical Aid, Pension etc.
Monthly Commission: Less Other Deductions:
Other Income: Spouse Salary:
    Nett Income:
Monthly Household Expenses
Bond Payment / Rent: Rates, Water and Electricity:
Vehicle Installments (excluding those to be settled): Personal Loan Repayments:
Credit Card Repayments: Furniture Accounts:
Clothing Accounts: Overdraft Repayments:
Policy / Insurance Repayments: Telephone Payment:
Transport Costs: Food and Entertainment:
Education Costs: Maintenance:
Household Expenses: Other Regular Payments:
Subtotal: Total Monthly Expenses:
       
Are you currently liable for: Please select an item.  
Specify Details:    
Bank Details
Bank Name: A value is required. Do you have a credit card: Please select an item.
Account Type: Please select an item. If yes which bank: A value is required.
Account No: A value is required. Credit card no: A value is required.
Branch: A value is required. Type:
Branch Code: A value is required.    
Vehicle Finance
Do you require finance: Please select an item.    
Preferred Bank:    
       
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