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Apply On-Line

T & C


Car & Van Gallery



Application Form

Please fill in the initial application form below. Enter as much Information as you possibly can to support your application. We do NOT take credit references through Credit reference agencies but we may confirm your details such as your registered address against the electoral roll or make other references to enable us to confirm that the infomation you have supplied is accurate.
We will require 2 documents to support you application to confirm you Identity such as a current drivers Licence showing the same address as your residence in the form below and also a recent Gas bill, Elecric Bill, Telephone Bill or Bank statement showing your current address as in the form below.
Please fill in all of the fields wth an * displayed as these are required fields.

* Buyers Name :-

* Address:-
     Your current address

* Tel:-

* Your email address:

* Date of Birth:

*  Time at this Address:
    Enter at least 3 Years recent addresses Details

* licence Number:
    The Long Number on your Drivers Licence

* Main Source of Income?:
     Ie Your employer, Income support, Pension

Additional Income Source:
    ie part time waiter McDonalds

* Weekly Income: Gross (Enter Numbers Only)
    (before deductions)

* Weekly Housing Costs (Enter Numbers Only)
     (rent, mortgage, board, etc.)*


* Weekly Food & Beverage Costs (Enter Numbers Only)
    enter average weekl costs or 0

Weekly Child Support (Enter Numbers Only)
    Enter amount or 0

Weekly Credit Card Repayments*
    (Enter Numbers Only)

* Weekly Debt Repayments* (Enter Numbers Only)

    Any additional Information to support your application

Vehicle You are Interested In:

* Amount of Deposit you have*: (Enter Numbers Only)
     Available funds you can afford to pay as an Initial payment


Buyers Signature :-
If you are filling this form in on line, type in your name.
This is a Digital Signature Enforcable in Law as being
your signature to authorise a transaction or agree to an
Enforcable Contract.

* Date :- : Date of your Application

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Rent2Own Cars and Vans Haslingden
Manchester Road