Apply for Finance

Bike Model*: required.

Bike Price(£)*: A valid number is required.

New/Used*: New Used required.

Full Name (as it appears on your Driving Licence)*: required.

Home Phone Number*: A valid phone number is required.

Mobile Phone Number*: A valid phone number is required.

Daytime Phone Number*: A valid phone number is required.

Email Address*: A valid email is required.

Date of Birth (mm-dd-yyyy)*: A valid format is required. (mm-dd-yyyy).

Status*: Married Single Divorced Separated

Accommodation details*: Home Owner Tenant Living with Parents Other

Number of Dependants (ie. Children under 18)*: A valid number is required.

Current Address

Employment Status*: Employed Self Employed Retired

Occupation*: required.

Employers Name: required.

Time in current Employment

Years*: 0 1 2 3+

Work Address Property No* required.

Road*: required.

Town*: required.

Postcode*: required.

Work Phone No*: A valid phone number is required.

Previous employers details (If Less than 3 yrs):

Please fill in the information below regarding your finance request. We will contact you to request your banking information upon receipt of the completed form.

Amount of Deposit (£)*: A valid number is required.

Loan Required (£)*: A valid number is required.

Term*: 12 Months 18 Months 24 Months 30 Months 36 Months 42 Months 48 Months 54 Months 60 Months

Gross Annual Income (£)*: A valid number is required.

Other material monthly expenditure that is not debt related such as School / University fees or maintenance etc. (£)*: A valid number is required.

Does this agreement replace an existing finance loan that will be repaid as a result of this agreement? No Yes

Would you be willing to proceed providing the application is successful:

Please select: Yes No