ABC Leasing - Referral Form

Your first name *

Your last name *

Your email *

Branch/Location *

Date of Referral *

Customer Details

Full Name *

Company Name (if Applicable)

Contact Number *

Email Address *

Preferred Contact Method *

Best Time to Contact

Preferred Vehicle Make & Model *

Alternative Vehicle Considered (If Any)

Body Type Preference *

Fuel Type Preference *

Transmission Preference *

Lease Type *

Contract Length (Years) *

Estimated Annual Mileage *

Initial Rental Preference *

Budget Per Month (Inc Vat for PCH - Exc VAT for BCH) *

Maintenance Package Required?

Vehicle Make & Model

Registration Number

Current Mileage

Outstanding Finance?

If Yes, settlement amount?

Any Specific Needs or Preferences (e.g. Delivery time, must have features)

Has the Customer Leased a Vehicle Before? *

Is the Customer Interested in an EV Home Charge Point Installation? *