Application Form Individual

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Company Name

Individual Name

Occupation

Have you ever:

Made arrangements with creditors including CVAs*

Yes

Had a property reposessed?*

Yes

Had a court order for debt registered against it?*

Yes

Failed to keep up repayments on any financial arrangement the business has entered into?*

Yes

Broken any credit agreements?*

Yes

Is there any information that you are aware of that may affect the success of the application that you feel you can provide to best assist us

Please Add Details For Individual

Title

Full name including any middle names

Date of Birth

DD slash MM slash YYYY

Full address

Date of entry to address

Previous Address if less than 3 years

Phone Number

Email Address

Ownership Status*

I consent to verify my identity and address electronically*

Yes

I understand that any personal data that I provide during the completion of this application form will be processed based on Bithell Davies Funding Solutions Limited's legitimate interest, which is to consider my request for arranging finance for my business or personal needs. I acknowledge that in doing this on my behalf, Bithell Davies Funding Solutions Limited will use my personal data to allow a lender party to make credit decisions and will share my personal data with lenders, credit reference and fraud prevention agencies. My personal data will be processed in accordance with Bithell Davies Funding Solutions Limited’s privacy policy, as set out in their disclosures. This policy can also be viewed again here

I am aware that, should my finance application be unsuccessful, Bithell Davies Funding Solutions Limited will retain my personal data only until it can be securely removed from their systems, within a maximum period of 12 months. I, the customer/applicant, confirm that I have read this statement and have been given the opportunity to read and accept Bithell Davies Funding Solutions Limited's privacy policy.”

Please confirm your acceptance of the above*

Yes

Signature*

Details of the Machinery/asset to Finance

Make

Model

Year Of Manufacture / New

Price

Is VAT Applicable?

Yes

Type of Transaction*

Facility Type

Supplier Name

Supplier Contact Name

Supplier Phone Number

Do you wish to defer the VAT?

Up Front Deposit Amount Separate To Any VAT

Payment Frequency

Would you like information on seasonal payment options?*

Yes

Would you like ito schedule lump sum payments?*

Yes

Do you have budget in mind?

Have you considered affordability of any repayments?*

Yes

Do you have a part exchange?*

Yes

If Yes:

Is VAT Applicable?

Yes

Is there outstanding finance remaining on this machine?*

Yes

What will the new machinery/asset do for you?

Do you have any agreements ending in the next 6 months that you are aware of?

Do you have any other needs that need to be taken into consideration?

Are there any positive or negative factors that you are aware of, or positive or negative foreseeable changes in circumstances that you wish us to take into account in the arranging of your finance?

Please select how you would like to hear from us?*

Phone

Mail

Text

Would you like us to send a copy of any agreements to your accountants?*

Yes

Can you confirm you hold or will ensure arrangement of valid insurance to insure the machinery/asset?*

Yes

Supporting Documentation

Max. file size: 32 MB.

Signature*

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