Application Form

Vehicle Make / Model

Deposit (If available)

Would you like to add a Deposit Amount?

Personal Details

Title

Name & Surname

Sex

ID Number

Country of Origin

Physical Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Address

Address Line 1

Address Line 2

City

State / Province / Region

Home Number

Work Number

Cell Number *

How long are you living at the above address?

Email

Dependants

Spouse Details

Are you married?

If Married how?

Spouse Name

Spouse ID Number

Spouse Cell number

Employer Name (Spouse)

Occupation (Spouse)

Employer Contact Number (Spouse)

Employer Address (Spouse)

Duration of work at the above Employer (Spouse)

Banking Details

Who do you Bank with?

Account type

Name of Account Holder

Bank Account Number

Branch Name / Number

Employment Details

Employer Name

Occupation

Employer Address

Employer Contact Number

Duration of work at the above Employer

Total Salary (Gross)

Monthly Commission

Car Allowance

Net take home pay

Income other than Salary / Wages

Total Monthly Household (Net + Other)

Both Spouses / Kids

Expenses

Bond Payment / Rent

Vehicle Monthly Installments

Credit Card Repayments

Clothing Accounts

Insurance Repayments

Transport Costs

Education Costs

Household Expenses:

Rates, Water, & Electricity

Personal Loan Repayments

Furniture Accounts

Overdraft Repayments

Telephone Payments

Food and Entertainment

Maintenance

Other

Total Monthly Household Expenses

Trade In (Fill in if you have a vehicle to Trade In)

Vehicle Year (Trade In)

Vehicle Make (Trade In)

Vehicle Model (Trade In)

Fuel Type (Trade In)

Petrol
Diesel

Colour (Trade In)

Mileage (Trade In)

Transmission (Trade In)

Accident Damage (Trade In)

Please Specify

Condition Of Vehicle (Trade In)

Service Book (Trade In)

Spare Key (Trade In)

Yes
No

Is your vehicle still under Finance? (Trade In)

Under Finance
Paid Up

If Unpaid, amount outstanding (Trade In)

Expected Value (Trade In)

Vehicle Pictures: (Trade In)

Please send your vehicle picture via Whatsapp to your sales representative.

Do You Agree with all the information provided above? *

Yes
No