Jason Muller - Online Finance Form for Used Cars

Jason Muller

Car Sales Assistant

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Cell: 068 778 2870
Email: jason@bargain-autos.co.za

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Applicant for Finance

Assisted By: *

Referral

Identification Type *

South African ID

ID Number *

ID Number (Confirm) *

Confirm ID Number

Do you have a valid Driver's License? *

Yes
No

Description of Vehicle You're Looking For

Instalment Type *

No Deposit
With Deposit

Deposit Amount *

Personal Details

First Name *

Middle Name

Surname *

Country Nationality *

Preferred Language *

Gender *

Male
Female

Title *

Mr
Advocate
Doctor
Professor
Reverend

Title *

Miss
Mrs
Advocate
Doctor
Professor
Reverend

Race *

Asian
Black
Coloured
White

Marital Status *

Single
Married
Divorced
Widower

Date of Marriage *//

Marital Contract *

ANC (Antenuptial Contract )
COP (Community of Property)
Tribal

Contact Information

Mobile Number *

Mobile Number

Work Number *

Work Number

Mobile Number (Confirm) *

Confirm Mobile Number

Work Number (Confirm) *

Confirm Work Number

Email

Email

Confirm Email

Residential Details

Residential Status *

Owner - Bonded
Owner - Bond Free
Tenant
Lodger
Living With Parents

Outstanding Bond Balance *

Residential Address (Home Address) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Period Here (Years) *

Period Here (Months) *

Employer Details

Employer Name (Company Name) *

Occupation (Job Title) *

Industry Type *

Private
Government
Mining
Farming
Self Employed

Employer Business Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Period Employed (Years) *

Period Employed (Months) *

Income & Expenses

Gross Salary *

As shown on payslip

Net Salary *

As shown on payslip

Frequency of Salary *

Monthly
Weekly
Fortnightly

Total Monthly Income *

Bond Payment

Monthly Rent

Water & Electricity

Car Payments

Personal Loan

Credit Card

Furniture Accounts

Clothing Accounts

Overdraft Payments

Policy / Insurance

Telephone Payments

Transport Costs

Food & Entertainment

Education Costs

Maintenance Expenses

Household Expenses

Relative Details

First Name (Next of Kin) *

Surname (Next of Kin) *

Relation (Next of Kin) *

Phone Number (Next of Kin) *

Address (Next of Kin) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

How did you hear of us? (Optional)

Newspaper Ad
Online Ad
Social Media
Friends
Other

Credit Provider Consent *

Yes, I authorize Murvan's Autos t/a Bargain Autos to share my data with contractually bound credit providers and their partner lenders to retrieve my credit report to assess my creditworthiness before making a final lending decision on my loan application. I authorize Murvan's Autos t/a Bargain Autos to contact, request, and obtain credit information from a registered credit bureau to verify my identity, perform an assessment of my behavior, profile, payment patterns, indebtedness, and creditworthiness, or for other related purposes in any format available from a registered credit bureau.