Finance application form - Open Road Dealers

Goods Description

new

used

Application Date (DD/MM/YYYY)

Model

Make

M&M Code

Cash Price (VAT inc)

Title

Surname

Identity Number

Full Names

Initials

Place of birth

Nationality

Gender

Male

Female

Martial Status

Date married

Home Address

Period

Country of Residence

Tel(H)

Tel(W)

Cell

E-mail

Spouse Name

Spouse Surname

Spouse ID Number

Spouse Cell Number

Next of kin

Relationship

Address of Kin

Tel of Kin

Are you a registered VAT vendor?

Yes

VAT reg no

Employer

Occupation

Industry

Employer Address

No of years

Salary Date (i.e 31st)

Previous Employer

No of years

Bank Name

Branch Name

Branch code

Name of account holder

Account No

Type of Account

Savings

Current

Basic Salary (R)

Spouse Salary (R)

Transport Cost/Expense (R)

Food and Entertainment Expense (R)

Clothing accounts (R)

Telephone payments (R)

1) I confirm that, (please select those applicable to you)

a) I am not a minor

b) I have never been declared mentally unfit by a South African court

c) I am not subject to an administration order

d) I do not have any current application pending for debt restructuring or alleviation

e) I do not have any current debt rearrangement in place

f) I have not previously applied for debt rearrangement

g) I am not under sequestration

h) I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act, 2005

i) if any of the above is incorrect, state which and give details

2) I hereby give consent to the credit provider to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the credit application and to share my payment behaviour with any credit agency

Yes

3) I hereby declare that all of the above information is true and correct

Yes

Signed at (Place)

on Day

Month

Year

Applicant Signature (Please insert Full Name and Surname)

Please email the following to sales@openroaddealers.co.za

3 Month Bank Statement

3 Month Pay Slips

Drivers Licence

If you are human, leave this field blank.

Application for Finance

Upload your car Photos

Provide a hosted video url of your car