Consumer Application - Page Automotive

Consumer Application Form

1. Requested Vehicle Details

* Annual Mileage * Preferred Colour * Monthly Rental

2. Personal Information

* Title * Full Name * Date of Birth * Address Line 1 * Address Line 2 * Town/City * County * Postcode

3. Contact Information

* Home Tel Number * Mobile Tel Number * Email Address

4. Employment Details

* Occupation * Employers / Trading Name * Employer Address line 1 * Employer Address line 2 * Town/City * County * Postcode * How long with current employer?

5. Income & Expenditure

* Net Annual Income (After Tax)

I confirm that the information I have provided is true & complete. I confirm that I give express permission to FlexxiCar to conduct personal searches or to provide third party finance houses or credit reference agencies this information for the specific purpose of ascertaining credit worthiness. I confirm that I have read and agreed to the FlexxiCar Privacy Policy I wish to receive promotional emails