SELECT AUTO, 144 Rietfontein Rd, Jansen Park,
Boksburg Tel 011 826-1580/2 Fax 011 826-1589
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DESCRIPTION MAKE & MODEL SALESPERSON
CASH PRICE (INCL. VAT) VATABLE EXTRAS (INCL. VAT)
ADD COVER
TERM
LANGUAGE
LICENCE / REG
NUMBER
PLATES RATE % FOR OFFICE USE ONLY
CREDIT LIFE
WARRANTY
AFFORDABILITY
DEP / TRADE IN
OTHER
RISIDUAL
EQUITY
TRADE
FINANCABLE AMOUNT
OTHER
INSTALLMENT
RETAIL
PERSONAL DETAILS
SURNAME
ID
No.
FULL NAMES
INITIALS
MARITAL STATUS DATE MARRIED DEPENDANTS
HOME ADDRESS
PERIOD yrs
TEL (H) TEL
(W)
CELL / FAX
E-MAIL
POSTAL ADDRESS
CODE
PREVIOUS ADDRESS PERIOD
yrs
SPOUSE NAMES
SPOUSE I.D..
NEXT OF KIN RELATIONSHIP
ADDRESS TELEPHONE
BOND DETAILS / BOND HOLDER AMOUNT OUTSTANDING
PROPERTY VALUE
INSTALLMENT Rpm
PURCHASE PRICE
DATE PURCHASED
REGISTERED RENTING R
EMPLOYER DETAILS / EMPLOYER OCCUPATION
EMPLOYER ADDRESS TELEPHONE
#
YEARS
SALARY DATE PREVIOUS EMPLOYER #
YEARS
SPOUSES EMPLOYER
#
YEARS
TELEPHONE OCCUPATION
SALARY DETAILS
OWN SPOUSE
BANKING
DETAILS BANK NAME
BASIC MONTHLY
BRANCH NAME BRANCH
CODE
COMMISSION
NAME OF
ACCOUNT HOLDER
CAR ALLOWANCE
ACCOUNT NUMBER
TOTAL
OTHER BANK ACCOUNTS
TRADE
REFERENCES
BRANCH
ACCOUNT NO.
INSTALLMENTS PAID UP / CURRENT / TO SETTLE
INS. BROKER
POLICY #. START DATE
CONTACT
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