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LEASING APPLICATION FORM
Company Name :
Company Registration No :
Years of Operation :
Nature of Business :
Business Address :
Postcode :
State :
Telephone No. :
Fax No. :
Contact Person :
Designation :
Mobile No. :
Email :
Section 2.0 - ENQUIRY PARTICULARS
Type of enquiry :
Vehicles Request :
Make :
Model Name :
Options :
Section 3.0 - CONTRACT DETAILS
Contract Type :
Contract Term :
Annual Mileage :
Notes :
Section 1.0 - BUSINESS PARTICULARS
--Please select--
Public Listed
Limited Company
Partnership
Sole Proprietorship
Multi-Company
Franchise Holdery
Concessionaire
Others
--Please select--
Johor
Kedah
Kelantan
Kuala Lumpur
Labuan
Melaka
N. Sembilan
Pahang
Penang
Perak
Perlis
Putrajaya
Sabah
Sarawak
Selangor
Terengganu
010
011
012
013
014
016
019
--Please select--
Passenger
Commercial
--Please select--
Cars
MPVs
SUVs
Trucks
Others
--Please select--
Alfa Romeo
Audi
BMW
Cherry
Chevrolet
Citroen
Ferrari
Ford
Honda
Hyundai
Inokom
Isuzu
Jaguar
KIA
Land Rover
Lexus
Mahindra
Mazda
Mercedes-Benz
MINI
Mitsubishi
Nissan
Perodua
Peugeot
Porsche
Proton
Renault
Skoda
Smart
SsangYong
Subaru
Suzuki
Volkswagen
Volvo
Toyota
--Please select--
--Please select--
Business Contract Hire
Personal Contract Hire
--Please select--
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
--Please select--
10,000 km
15,000 km
30,000 km
45,000 km
60,000 km
75,000 km
90,000 km
Other - Please specify in notes section below
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