Motor Finance Initial Enquiry Step 1 - Personal InformationStep 3 - Confirmation Step 1 - Personal Information Please add your details below: Personal Information Title * MrMrsMissMsOther Title First Name * Middle Name Surname * Date of Birth * Please enter Date of Birth using dd/mm/yyyy format. Section Home Telephone Number Mobile Telephone Number Email Address * Contact Address Address Line 1 * Address Line 2 Address Line 3 Town * Post Code * Additional Information Did you have a different name when taking out the credit? Yes No Previous Name(s) Did you have a different address when taking out the credit? Yes No Previous Address 1 Previous Address 1 Address Line 1 Address Line 1 Address Line 2 Address Line 2 Town Town County County Post Code Post Code Did you have another previous address when taking out the credit? Yes Previous Address 2 Previous Address 2 Address Line 1 Address Line 1 Address Line 2 Address Line 2 Town Town County County Post Code Post Code Did you have another previous address when taking out the credit? Yes Previous Address 3 Previous Address 3 Address Line 1 Address Line 1 Address Line 2 Address Line 2 Town Town County County Post Code Post Code Did you have another previous address when taking out the credit? Yes Previous Address 4 Previous Address 4 Address Line 1 Address Line 1 Address Line 2 Address Line 2 Town Town County County Post Code Post Code Did you have another previous address when taking out the credit? Yes Previous Address 5 Previous Address 5 Address Line 1 Address Line 1 Address Line 2 Address Line 2 Town Town County County Post Code Post Code Did you have another previous address when taking out the credit? Yes Previous Address 6 Previous Address 6 Address Line 1 Address Line 1 Address Line 2 Address Line 2 Town Town County County Post Code Post Code Step 2 - Lender Information Please tick the if you have ever had a loan or credit card with any of the following: Checkboxes Audi (VW Financial Service) Barclays Partner Finance Black Horse BMW Financial Services (Inc Mini) Close Brothers Ford Financial Services Mercedes-Benz Financial Services MotoNovo Vauxhall Finance Volkswagen Financial Services Volvo Car Financial Services Any other lenders? (please separate with a comma) Step 3 - Confirmation Have you been declared bankrupt, subject to an Individual Voluntary Arrangement (IVA) or similar arrangement? * Yes No Do you consider yourself to have any disabilities or additional needs? Yes No If yes, we will contact you before proceeding with your claim to discuss any additional requirements you may have. By clicking submit you confirm the following; You have read and agreed to our privacy policy You consent to your e-signature being applied to our letter of authority which is the document we will send to your finance provider telling them that we have authority to represent you You consent to Consumer Refund Service contacting you by email, SMS, telephone and WhatsApp to complete your claim enquiry. You have read, understand and consent to our pre-contractual information and terms and conditions and consent to your e-signature being applied to them. In accordance with our terms and conditions, if your claim is successful our fee is between 15% and 30% plus VAT of any compensation you receive. Signature signature keyboard Clear If you are human, leave this field blank.
