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Customer Details
Title
Mr
Mrs
Miss
Ms
Sir
Dr
First Name
Surname
Address
Post Code
Tel
Mobile
Email
Are you VAT Registered?
Yes
No
Date moved in
Previous Address (if less than 4 years)
Post Code
Time at Address
Yrs
Months
Owner
Tenant
Tenant Unfurnished
Married
Single
Divorced
Cohabiting
Date of Birth
NO. of dependents
Nationality
Country of birth
Goods Details
Make
Model
Colour
Petrol / Diesel
Outstanding Debts
Name of Lender
How much outstanding
Monthly Payments
Terms Remaining
Direct Debit Details
Bank A/C Name
Bank A/C Number
Sort Code
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0161 850 0106
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