Finance Enquiry:

172 Nissan QASHQAI (83) 1.5DSL N CONNECTA **TOP SPEC** ++EURO++70 P/W

Please complete this form and we will be in touch to respond to your query.

I am over 18 years of age *

The car I am buying is more than €5,000 *

Step 1: Personal Details

Full Name: *

Email: *

PHONE NUMBER *

date of birth:

PLACE OF BIRTH *

PPSN *

Step 2: Your Residential Details

HOME ADDRESS *

Step 3: Your Employment Details

Occupation: *

EMPLOYER'S NAME *

EMPLOYER'S ADDRESS *

TIME WITH EMPLOYER: *

PREVIOUS EMPLOYER'S ADDRESS (IF APPLICABLE)

Step 4: Your Financial Details

NUMBER OF DEPENDANT CHILDREN: *

NET SALARY PER MONTH: *

€

OTHER INCOME PER MONTH: *

€

RENT/MORTGAGE PER MONTH: *

€

Step 5: Car Finance Details

Do you have a car you wish to trade-in?:

Yes

FINANCE TERM:

FINANCE AMOUNT:

€

I hereby consent that my data can be used for the application of finance

I have read and agreed to Boland Carlow's privacy policy

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