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Vehicle on our website, you are interested in

Full Names

Surname

Male/Female Male/Female Male Female

Ethnic group Ethnic group A B C W

Cellphone number

Id number

Residential Address

Years at address

Name of Employer

Work Address

Work number (landline)

Marital Status Marital StatusSingleMarriedWidowedDivorced

Date Married

In Community In Community Yes No

Basic Salary before deductions (gross)

Salary after deductions (nett)

Where do you bank?

Bank account number

Type of account Type of account Check account Savings account

MONTHLY EXPENSES: Bond payment

Rent

Rates / Water & Electricity

Vehicle Instalment (excl. instalments to be settled)

Personal Loan Repayments

Credit Card Repayments

Furniture account/Clothing account repayments

Telephone payments

Transport Costs

Relative name & surname

Relative Residential Address

Relation

Tel No

Do you want to trade in

Year model

Make

Current km

Settlement amount

Bank where vehicle is financed?

Finance account number