Apply For

Banrep Stock No (Showroom)		I'm looking for the following vehicle
	OR

Deposit & Trade-In

Available Deposit
Trade-In
Model		Make
Description		Settlement Amount

Personal Details

Surname		Full Names
ID No		Title	Please Select Mr Mrs Miss Dr Prof Past Rev
Married		Date Married

Contact Details

Cell		Tel (W)
Tel (H)		Fax
Email Address

Address Details

Home Address
Street Address		Suburb
City		Province
Postal Code		Period At Address
Postal Address
	Please select Use Address Below Use Home Address
PO Box		Postal Suburb
Postal Code

Relative Details (Next Of Kin)

Name		Surname
Tel		Relationship
Relative Address
Street Address		Suburb
City		Province

Employment Details

Employer		Occupation
Period Employed
Employer Address
Street Address		Suburb
City		Province

Bank Details

Bank Name		Branch Name
Branch Code		Account Holder
Account No		Account Type	Please Select Credit Card Savings Transmission Current

Bond Details

Bond Holder		Amount Outstanding
Property Value

Income Details (Monthly)

	Your Income		Spouse Income (Only If Married)
Salary (Gross)
Car Allowance
Commission
Other
Nett (Take home pay)

Household Expenses (Monthly)

Rent / Bond		Vehicle Instalments
Electricity		Personal Loan
Credit Card		Furniture Accounts
Transport		Clothing Accounts
Education		Telephone
Maintenance		Food/Entertainment

Spouse Details

Spouse Names		Spouse ID No
Tel

Declaration by Client:

I hereby grant the credit Provider the right to:

i. to increase my Credit Limit once every year to accommodate any Value added Products needed;
ii. to authorise the Credit Provider to make enquiries about my credit record with any credit agency;
iii. to obtain whatever information on me they might require to process application;

I understand that I will be liable for a monthly service fee.
I also authorise the Credit Provider to share my payment behaviour with any credit agency and the National Loan Register

By Submiting your application you agree to the terms above