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

                      Print this Finance Application Form and Fax it back to Select Auto  (011)  826-1589