Customer Financing Registration

Customer Financing Application

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Which item(s) would you like to get?

Your Full Name

First

Last

Confirm Email

Main Phone

ID Number

ID/DP/Passport

ID Type

Upload front and back of your ID *

Upload a selfie holding your ID

Additional Customer Info

Gender

Date of Birth

Nationality

Upload a copy of a recent utility bill

Upload a copy of a recent pay slip

Upload a copy of a job letter

MARITAL STATUS

Marital Status

Do you have any dependents?

Selected Value: 0

Home Address - Line 1

Home Address - Line 2

Simple directions to your Home Address: *

Type of Residence

Number of years at the address

Selected Value: 0

Do you currently make rent or mortgage payments?

EMPLOYMENT DETAILS

Current Occupation

Employment Status

Number of Years you've been employed there

Number of Months you've been employed there

Current Work Address

Current Employer

How often do you receive your salary/wages?

Work Phone Number

Gross Monthly Income

Net Monthly Income

Do you currently receive any other income?

REFERENCE 1

Blood relative that does not reside in the same household

Name

First

Last

Reference Address

Reference Address (copy)

Phone

Relationship Type?

REFERENCE 2

A close friend that does not reside in the same household

Name

First

Last

Reference Address

Phone

Relationship Type?