Application

PLEASE COMPLETE THIS APPLICATION FORM

EMPLOYER DETAILS

BANK DETAILS

I hereby agree that the information above is true and correct *

DRIVING DETAILS

LANGUAGE PREFERENCE

BOND DETAILS

HOUSEHOLD / INCOME DETAILS PER MONTH

SELECT:

HOUSEHOLD & EXPENSES PER MONTH

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. *
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. *
I hereby declare that all information provided above is true and correct *