Alan Duffus Finance Application

Please complete the following form. Upon receipt we will process your application and contact you.
Please note: This application is not a guarantee of finance, nor is it a binding contract.
The information you provide on this form will be used solely to give you a preliminary idea of the finance options available to you. It will not be passed on to any third parties.

Personal Details
Title (Mr, Dr etc)	Forename	Surname

Date of Birth	Marital Status	Previous Surnames
	Married Single Widowed Divorced/Separated
Number of Dependent Children
Home Telephone	Mobile Telephone	Work Telephone

Email

Address Details - We require 3 years of address history
Residential Status Home Owner Tenant Living With Parents
Current Address		Time at Address
		Years: Months:



Previous Address 1		Time at Address
		Years: Months:



Previous Address 2		Time at Address
		Years: Months:



Employment Details
Employment Status	Employment Type	Occupation
Full Time Part Time	Permanent Temporary
Time with Employer	Years: Months:
Employer Name
Address
Post Code
Phone Number
Financial Details
Bank/Bldg.Soc.	Sort Code
Time with Bank	Years: Months:
Cards Held	Cheque Guarantee Visa Access Other
Payment Protection Plan	If you would like your payments protected for life/accident/sickness and redundancy please indicate here. You should be aware that payment protection will incur a slightly higher monthly payment that taking a loan without this plan.
Yes No
If you indicate approximately how much you would like to put down as deposit and roughly how much a month you would like your payments to be then we will propose the application that is closest to your indicated monthly figure.
My preferred deposit would be
My preferred monthly payment would be
Motorcycle Details
Registration No.	Please enter the registration number of the motorcycle you are interested in - we will fill in the rest.

Part Exchange Details
Make	Model

Mileage	Registration Number	Year of Manufacture

Other Information

Please enter any other information, e.g. after market mods. etc.
Other Information

Please enter any other information you feel we should know regarding this proposal.

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