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*First Name:

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Landline Number:

*Company Name:

Company Type: Company Type:Limited CompanyLimited Liability PartnershipPartnership (4 or more partners)Partnership (less than 4 partners)Sole Trader

Company Registration Number:

Number of Years Trading: Number of Years Trading:Not started yetLess than 1 year1 to 3 years3 years plus

What does your business do?

Goods to be: Goods to be: Financed Refinanced

What’s it for?

Make:

Model:

Year of manufacture:

Purchase price:

Current value (if known):

Amount Required: Amount Required:10,00020,00030,00040,00050,00060,00070,00080,00090,000100,000110,000120,000130,000140,000150,000160,000170,000180,000190,000200,000

Term of Agreement required Term of Agreement required6 months1 year18 months2 years3 years4 years5 yearsother

Credit History: Credit History:ExcellentGoodFairPoor

Shareholder / Proprietor Details: Shareholder / Proprietor Details:

Full Name of Business Shareholder(s)/ Proprietor(s)**:

Date of Birth:

Residential Address of Business Shareholder / Proprietor:

If more than one shareholder/proprietor click here to add details** If more than one shareholder/proprietor click here to add details**

Full Name of Business Shareholder(s)/ Proprietor(s)**:

Date of Birth:

Residential Address of Business Shareholder / Proprietor:

Full Name of Business Shareholder(s)/ Proprietor(s)**:

Date of Birth:

Residential Address of Business Shareholder / Proprietor: