Mon - Fri 8.00 - 17.00, Sat 9.00 - 13.00
119 Pretoria Road, Boksburg, Gauteng
+27 81 750 4245
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081 750 4245
119 Pretoria Road , Boksburg
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Choose a Sales Representative
2
Personal Details
3
Next of Kin
4
Spouse Details
5
Bank Details
6
Employment Details
7
Expenses
8
Trade In
Choose a Sales Representative
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Neels
Vulo
Preference
Mohammed Asif
Roxanne
Imran
Vanessa
Ahmed
Zelda
Please select one Sales Representative to assist you with the process.
Vehicle Make / Model
Deposit (If available)
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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
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Next of Kin (Next of kin must be someone who doesn't live with you.)
Name: (NextOfKin)
Surname: (NextOfKin)
Contact number: (NextOfKin)
Address: (NextOfKin)
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Spouse Details
Are you married?
Date of Marriage?
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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)
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Banking Details
Who do you Bank with?
Account type
Name of Account Holder
Bank Account Number
Branch Name / Number
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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
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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
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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)
Excellent
Good
Fair Condition
Need Attention
Service Book (Trade In)
Service History (Trade In)
Full Service with Franchise
Full Service Partially with Franchise
Full Service not at Franchise
Partially Serviced
No Service
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.
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