Finance Application Form

Type of Finance:

Vehicle Description

Make:                                           M&M Code:      

Purpose for which car is required

Period of contract:

Personal information

Your title:
Your surname:
Your names:
Your ID

Residential information

Present residential address: Previous residential address: Postal address:
Postal code: Postal code: Postal Code:
How long at present address ? years    months
Dou you have your own property ?    Estimated Value  Outstanding Bond
Outstanding Bond ?    Which Bank is Bondholder 
How long at previous address ? years    months
Home Area code and Tel no:
Cell phone number:
E-Mail Address:

Occupation / Employment information

Company name:
Company telephone no.:
Employers Occupation:
Type of Industry:
Employers Name:
Employers Address: Previous Employers Address:
Postal code:                                               Postal Code:
How long with your present employer ? years months
How long with your previous employer ? years months
What is your gross monthly income ? R per month
What is the value of your car allowance ? R per month
Addisional Income: R per month
Total Income: R per month

Marital Status

Status: Single Married Widowed
Date Married:

Spouses Details

Salary per Month:
Id. Number:
Date of Birth:
Employer Name:
Employer Address:
Period of Employment at current Employer:

Relatives Details

Name of next of kin not living with you:
Address of next of kin not living with you:
Area Code & Tel No:

Banking Details

Which Bank do you bank with:
Type of Account: Savings   Cheque   Transmission
Type of Credit Card: None Visa  Master card  Other

Do you have existing or previous accounts with vehicle finance ?

Name of Company you financed with:
What type of account do you have:
Do you have your own insurance:

If deposit is a trade in, Please specify Make, Model and Year

Make: Model:
Year: km Settlement Amount 
Any extras eg. (New tyres etc.):

Please Print this Finance Application Form and Fax it back to Select Auto (011)