Finance Application Form...
Please complete the form information below as accurately as possible
Have you had problems realting to not getting finance?
Yes
No
(This question must be answered to complete the form)
Title
*
Mr
Mrs
Miss
Ms
First Name(s)
*
Surname
*
Email
*
Marital Status
*
Married
Single
Divorced
Common Law
Date Of Birth
*
01
02
03
04
05
06
07
08
09
10
11
12
13
14
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17
18
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25
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30
31
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
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1959
1960
1961
1962
1963
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1965
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1967
1968
1969
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1971
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1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
Address
*
Postcode
*
Telephone
*
Mobile
Ocucupancy Type
*
Owner
Private Tenant
Council Tenant
Housing Association
Parents
Other
How long have you lived in your present location?
*
Years
0
1
2
3
4
5
6
7
8
9
10
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Previous Address if less than 3 years
*
Postcode
*
How long have you lived in your previous location?
*
Years
0
1
2
3
4
5
6
7
8
9
10
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Take Home Pay
*
Weekly
Monthly
Computerised Wage Slip
Current Employer
*
Occupation
*
Employer's Address
*
Employer's Telephone
*
How long have you worked for this employer?
*
Years
0
1
2
3
4
5
6
7
8
9
10
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Previous Employer if less than 3 years
*
Previous Occupation
*
Previous Employer's Address if less than 3 years
*
Previous Postcode
*
How long did you work for this employer?
*
Years
0
1
2
3
4
5
6
7
8
9
10
10+
Finance Regarding
*
select
Citroen Berlingo XTR HDI - £sold
Citroen BERLINGO M,SPACE VTR 1.6 HDI - £6990
Mini Cooper D - £7480
Toyota Aygo Blue VVTI - £3995
Vauxhall Vivaro Combi Air-Con - £8995
Volkswagen CADDY MAXI LIFE 104 TDI - £sold
Term Of Finance
*
Years
1
2
3
4
5
Payment Protection
Bank Name
*
Period With Bank
*
Years
0
1
2
3
4
5
6
7
8
9
10
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Deposit
*
Cash / Part Ex
Data Protection Notice 1998
In considering your application we will search your record at a credit reference agency. They will add to your record details of our search and your application and this will be seen by other organisations carrying out later searches. It is important that you give us accurate information. We will check your details with fraud prevention agencies and if you give us false or inaccurate information and we suspect fraud we will record this. We and other organisations may use and search these records to help make decisions about credit and credit related services, for you and members of your household; trace debtors, recover debt, prevent fraud, and to arrange your accounts or insurance policies; check your identity to prevent money laundering unless you furnish us with other satisfactory proof of identity. You have a right, on payment of fee, to receive a copy of the information we hold about you if you apply to us in writing. We may pass on your details to other companies to send information about the product.
I agree