Active Vehicle Solutions

E-Mail

TEL:
08707 492100
08707 492101
FAX:
08707 492111

E-Mail

(C) 2006 D.R.Pemberton

Business Finance Proposal Form

Data Protection Act 1984: I consent to Active Vehicle Solutions using and disclosing the information contained in this form :-

1. To authorised agents and licensed credit reference agencies to make enquiries for credit assessment purposes. Such agencies will keep a record of the enquiry, and will share that information with other businesses.
2. To assist in fraud prevention and detection, and tracing debtors.
3. For registration with licensed credit reference agencies.

Under the Data Protection Act 1984 (The Act), information held by Active Vehicle Solutions will be used only for the purposes registered under The Act including general business purposes, making credit decisions and marketing.

I CONSENT TO THE ABOVE *

Customer details -

Business Name *
Address *
Postcode * Tel * Fax
Email Address
Sole Trader Partnership Limited Company

Type of Business *
Date Established *
Owner/Tenant *
Owner/Tenant since *
Company Reg Number *
VAT Number *

Proprietor/Partners/Directors Details -

First

Title *
First Name *
Surname Name *
Address *
Postcode * Tel *
Time at current address (years) *

(If at current address less than three years)
Previous Address
Date of Birth *
Owner Tennant Living with parents
Single Married Other

Second

Title
First Name
Surname Name
Address
Postcode Tel
Time at current address (years)

(If at current address less than three years)
Previous Address
Date of Birth
Owner Tennant Living with parents
Single Married Other

Bank Details -

Bank Name *
Bank Address *
Postcode *
Sort Code *
Account Number *
Time With Bank *
Account Name *

Vehicle Details -

Full Model Description *
Options - Factory Fit
Options - Dealer Fit
Requested Del Date
Payment Pattern
Annual Mileage
Maintenance
Quantity
Term
Monthly Payment
Excess Mileage

enquiries@activevehiclesolutions.co.uk
Cliffe View Farm Office, Flappit Springs, Keighley, BD21 5QB
Telephone: 08707 492100/492101 . Facsimile 08707 492111
Partners: T. Whitaker & K.M Whitaker
VAT Registration No 746 3662 13 * Consumer Credit licence No 491279