EZ
ABOUT
TEAM
PRODUCTS
GET YOUR WHEELS
CARS
KNOW YOUR FACTS
EZ CELL
LUXURY & SUPER CARS
EZ TRUCKS
CONTACT
EZ
ABOUT
TEAM
PRODUCTS
GET YOUR WHEELS
CARS
KNOW YOUR FACTS
EZ CELL
LUXURY & SUPER CARS
EZ TRUCKS
CONTACT
Application
PLEASE COMPLETE THIS APPLICATION FORM
TITLE
*
INITIALS
*
FULL NAME
*
SURNAME
*
ID NO
*
GENDER
*
MALE
FEMALE
CURRENT ADDRESS (and where car will be kept overnight)
*
PERIOD LIVED HERE
*
WORK ADDRESS (Head office and actual branch worked at)
*
POSTAL ADDRESS
*
PREVIOUS ADDRESS
*
PERIOD LIVED HERE
*
TEL (H)
*
TEL (W)
*
TEL (C)
*
EMAIL
*
SPOUSE NAME
*
SPOUSE EMAIL
*
NEXT OF KIN
*
RELATIONSHIP
*
ADDRESS
*
TEL
*
EMPLOYER DETAILS
EMPLOYER
*
OCCUPATION
*
EMPLOYER ADDRESS
*
TEL
*
NUMBER OF YEARS WORKED
*
SALARY DATE
*
PREVIOUS EMPLOYER
*
NUMBER OF YEARS WORKED
*
SPOUSE EMPLOYER
NUMBER OF YEARS WORKED
OCCUPATION
TEL
BANK DETAILS
BANK NAME
*
BRANCH NAME
*
BRANCH CODE
TYPE OF ACCOUNT
*
CHEQUE
SAVINGS
NAME OF ACC HOLDER
*
ACC NUMBER
I hereby agree that the information above is true and correct
*
I AGREE
DRIVING DETAILS
DO YOU HAVE A VALID DRIVER'S LICENSE?
*
YES
NO
DRIVER'S LICENSE NUMBER
*
DRIVING EXPERIENCE (ACTIVE)
*
DO YOU TRAVEL ON DIRT ROADS?
*
YES
NO
LANGUAGE PREFERENCE
CHOOSE YOUR LANGUAGE
*
ENGLISH
AFRIKAANS
ZULU
SOTHO
APPLICANT ID
*
APPLICANT INITIALS
*
APPLICANT SURNAME
*
BOND DETAILS
BOND HOLDER / BANK
*
AMOUNT OUTSTANDING
*
PROPERTY VALUE
INSTALLMENT PER MONTH
PURCHASE PRICE
DATE PURCHASED
HOUSEHOLD / INCOME DETAILS PER MONTH
SELECT:
*
PRIVATE INDIVIDUAL
SELF-EMPLOYED
GROSS REMUNERATION
*
MONTHLY COMISSION
*
CAR ALLOWANCE INCLUDED IN GROSS
*
NETT TAKE HOME PAY
*
INCOME OTHER THAN SALARY/WAGES
*
SOURCE OF INCOME
*
TOTAL MONTHLY HOUSEHOLD INCOME
*
HOUSEHOLD & EXPENSES PER MONTH
BOND PAYMENT/RENT
*
RATES, WATER & ELECTRICITY
*
VEHICLE INSTALMENTS (EXC TO BE SETTLED)
*
PERSONAL LOAN REPAYMENTS
*
CREDIT CARD REPAYMENT
*
FURNITURE ACCOUNT
*
CLOTHING ACCOUNT
*
OVERDRAFT ACCOUNT
POLICY/INSURANCE REPAYMENT
*
TELEPHONE PAYMENT
*
TRANSPORT COST
*
FOOD & ENTERTAINMENT
*
EDUCATION COSTS
*
MAINTENANCE
HOUSEHOLD EXPENSES
*
OTHER
*
If any of the above is incorrect, please provide details:
DECLARATION BY CLIENT
I hereby grant the Owner or Agent of EZ Wheels the right to communicate with me through any electronic / written media or verbally to make available to me, their product offering and to utilize my information for supporting products as communicated by one of the Credit Provider’s Partner.
*
Yes
No
I hereby grant the Owner or Agent of EZ Wheels the right to increase my credit limit once every year to accommodate any value-added product needed and requested by me.
*
Yes
No
I hereby declare that all information provided above is true and correct
*
Yes
FULL NAME
*
DATE
*
If you are human, leave this field blank.
Submit