Customer Form Title * Mr Mrs Miss Name * First Name Last Name Email * Phone Number * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Marital Status Single Married Divorced Widowed Separated Date Of Birth * MM DD YYYY Residential Status * Home Owner Private Renting Council Rental Living With Parents Living With Partner Student Accommodation Other Accommodation Have You Lived At Current Address For More Than 3 Years? More than 3 years Less than 3 years Income Per Month (After Tax) * Employment Status * Employed Self Employed Unemployed Retired Student Desired Vehicle * Audi A5 (HJ72) - £1200 (7-14) Audi Q2 (HJ72) - £699 (Onsite) Audi A3 (LM23) - £895 - (Onsite) Audi A4 Black edition - £995 - (Onsite) BMW 218 I M sport Grand coupe - £1100 (7-10) BMW M135I X Drive Tech and Pro Pack - £1200 (7-10) Kia Sportage (RJ73) - £750 (7days) Kia XCeed GT Line Manual (24) Red/Silver - £550 (7-14 Days) Landrover Defender 110 (23) - £2500 (Onsite) Mercedes GLA200 Executive - Dark Blue £950 (7-10) Merc CLA (gy72) - £950 (7days) Mercedes V Class (23) - £1500 (7-14 Days) Mercedes V Class (23) - £1500 (7-14 Days) Mercedes A Class (GY22) - £850 - (Onsite) Nissan Qashqai (BT72) - £775 (7-14) Peugeot Partner (24) - £700 (7 Days) Renault Clio (72) - £350 (7 Days) SKODA OCTAVIA ESTATE 1.5 TSI SE Technology 5dr White/Silver (FH24) - £640 (Onsite) S-Cross Ultra All-Grip Manual – Suzuki S-Cross Ultra Mild Hybrid - £695 (Onsite) S-Cross Motion Manual – Suzuki S-Cross Motion Mild Hybrid - £695 (Onsite) S-Cross Motion AGS (Auto) – Suzuki S-Cross Motion Full Hybrid - £725 (Onsite) Tesla Model Y Long Range (GD23) - £1200 (7 -10) Toyota BZ4X (24) - £695 (7 days) Toyota CHR (KM23) - £625 (7-14 Days) VW Amerok (MJ73) - £1300 (Onsite) VW Golf Life (23) - £625 (7 Days) Vitara SZ-T Manual - Suzuki Vitara SZ-T Mild Hybrid - £650 (Onsite) Frequency of Main Income * Weekly Fortnightly Monthly Irregular Paid into UK Bank Account? * Yes No Other Do You Have Any Adverse Credit? (Please tick one only) * No Yes - CCJ in the last 6 months Yes - CCJ over 6 months ago Yes - Multiple CCJ's Yes - I'm in an IVA Yes - Missed Payment in the Last 6 Months Yes - Unsure Why Do You Have Any Points On Your License? * No Yes - Recent Attended A Speed Awareness Course Yes Affordability Confirmation - I'm able to demonstrate affordability if required with Bank Statements * Yes No Do you understand that you will insure the vehicle yourself and send a copy of the Insurance Certificate to M1 Auto Lease or The Vehicle Provider as Proof? * Yes No * I declare that the information supplied on the Customer Form is true and correct. I am aware that a Soft Credit Search may be done and that my credit history (IVA's, CCJ's etc) may be used in the decision-making process. I agree that the funder can at any time disclose details about the application, agreement and the conduct of the account to a Financial Conduct Authority (FCA) regulated credit agency, or introducing Funder / Broker for the purposes of: fraud/crime prevention, tracing customers and any other legitimate purpose. I also acknowledge that the funder may refuse to enter into this agreement without stating a reason. I understand and agree that any personal details within this application may be passed to a third party as part of the underwriting process. However, the details provided will not be used for marketing purposes. I authorise M1 Auto Lease or A Vehicle Provider that they work with to use the information above for the purpose of a Short Term Leasing Proposal. I understand that my information submitted will be used to perform an identity check for affordability and reliability to obtain a vehicle lease option. This will not affect your credit. All information stated in this application is declared to be a true representation of the facts and made for the purpose of obtaining the Finance Approval / Affordability Screening by one or multiple Lenders. I have read and understood this disclaimer and wish to proceed. Thank you!