LOAN APPLICATION APR 16.9% Variable Term
Financial Details
   
Product 1 Price
 Deposit (minimum 0%)
    
Product 2 Price
 Loan Amount
Product 3 Price
 Chosen Term


   
Total Price  
     
   

 
Customer Details
   
Name
Middle Name/s Surname
 
Date
of birth
 Time at current address (years)
 Current Address
House No./Name
 Current Address
Street
Current
Address
Town
Current
Address
Postcode
 Previous Address
(if current address
less than 3 years)
 
Home Phone No. Mobile Phone No. E-mail address
Marital Status
 Number of Children
Property Type Mortgage

Years mortgage held

     
Employment
Status
 Work
Phone No.
 Years
employed for?
Employer's
Name 		Your
Occupation 		Branch /
Department
Work address
No./Street Name
 Work address
Town
 Work address
Postcode

Are you picking up your goods from the store?

 
 

Main card number
(16 digits) (for credit check only) 		Time with your bank (Years) Sort
Code 		Account
Number
Terms & Conditions A

Please read the following statement regarding the uses of your information. Please indicate your acceptance below. If you do not agree to the uses of your information, we will not be able to process your application.

Credit facilities are Provided by Hitachi Capital (UK) PLC trading as Hitachi Capital Consumer Finance We will pass your information to Hitachi who will make a search of a Credit Reference agency. The agency will supply credit information, including information from the Electoral Register, and will record details of the search whether or not this application proceeds. Credit scoring methods may be used to assess your application and to verify your identity.

Hitachi may make searches of their Group records and at Fraud prevention agencies who will supply them with data. Hitachi may also pass information to organizations involved in Fraud Prevention to protect themselves and their customers from fraud. Hitachi will also record any suspicion of Fraud. Hitachi and other companies may use any of this information if decisions on credit or insurance facilities are made about you or others at your address(es). Any of this information may also be used for tracing and claims assessment.
Can you confirm that in making this application if you provide details of your
partner that you are entitled to do so?
Terms & Conditions B

It is important that you understand that information held about you by the credit reference agencies may be linked to records relating to one or more of your partners. For the purpose of this application you may be treated as financially linked as your application will be assessed with reference to any "associated" records. You can ask Hitachi for details of the credit reference agency and fraud prevention agencies used.

Do you want to proceed with this application?