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37 Siddle St, Klerksdorp Central, Klerksdorp, 2571

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Home
Showroom
Sell Your car
Finance
- APPLY FOR FINANCE
- FINANCE CALCULATOR
Our Team
Contact Us

APPLY FOR FINANCE

QUICK & EASY

Complete the application form below.
Once submitted, one of our Sales Executives will get in touch with you.

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Personal Details

Title*

First Names*

Surname*

ID Number*

Gender*

Male

Female

Race*

African

Indian

Coloured

Asian

White

Other

Contact Number*

Alternate Number

Email*

Relationship Status*

Single

Married COP

Married ANC

Widow

Spouse Name

Spouse ID

Wedding Date

Physical Address

Address*

Street Address Address Line 2 City Province Postal Code

Period living at address?*

Next of Kin

(Someone not living with you)

Name and Surname*

Relationship*

Address

Contact Number*

Banking Details

Account Holder*

Account Number*

Bank*

Branch Code*

Account Type*

Savings

Cheque

Transaction

Credit Card

Other

Employment Details

Company Name*

Job Title*

Company Address

Company Phone Number*

Years at Company*

Salary Date*

Income Details

Basic Monthly Salary (Excl Car Allowance)*

Total Salary (Car & other allowances included)*

Commission

Net Take Home Pay*

Alternative Income

Source of Alternative Income

Monthly Expenses / Debit Orders

Rent / Bond

Credit Card

Policies & Insurance

Rates, Water & Electricity

Personal Loan

Furniture Account

Clothing Account

Transport

Maintenance

Food & Entertainment

Telephone Account

Overdraft

Consent*

I hereby give consent to the Credit Provider to make inquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the application. I also give my consent to the Credit Provider to share my payment behavior with any credit agency.

Yes

No