APPLY FOR FINANCE Name Email Address I am over 18 years of age I am over 18 years of age yes no I am in full time employment I am in full time employment yes no The car I am buying is over €5,000 The car I am buying is over €5,000 yes no Date of birth --/--/---- Place of birth Marital Status Phone number Address Time at address Previous address -if less than 3 years at current address Employment Type Employment Type Permanent Temporary Contract Occupation Employer name Employer address Time with Employer (Years/months) No of dependant children Net salary (per month) Other income (per month) Past employment (if less than 3 years in current position) Past employer's name Past employer's address Past employment duration Bank Branch Time with branch Car Details Trade In ( Deposit + Trade in Value must be minimum 10% car value) Trade In ( Deposit + Trade in Value must be minimum 10% car value)YesNo Deposit amount Trade in value Finance Term Finance Term36 months48 months60 months Finance amount Data Protection and Consents Data Protection and Consents I AGREE TO THE FOLLOWING :Data Protection and Consents The information that you provide on this proposal form will be forwarded to one or more financial institutions, being members of the Irish Finance Houses Association, and will be used by them for the purposes of assessing the suitability for you of their finance products, potentially offering you a product or a quote. As part of this process, credit searches will be made with one or more credit reference agencies, including the Irish Credit Bureau (ICB), which will make a record of the search. Details of any agreement you enter into, and your conduct of that agreement, may be shared with the credit reference agencies, ICB and their members. Searches may also be carried out to verify your identity, and you may be contacted directly (including by telephone) for the purposes of verifying the information on this form. Credit scoring and other automated decision-making process may be used. By ticking I certify that I consent to the use and disclosure of this information for the purposes set out here. I acknowledge that the recipients of this information are authorised to contact me and to disclose any material misstatements of fact on this proposal to their members and other relevant bodies. APPLY NOW