Request Form - Prudence Leasing

FORMULAIRE DE

DEMANDE

Titre :

Employeur :

Prénom :

Poste occupé chez l'employeur :

Nom de famille :

Revenu mensuel net : (RS)

Numéro de portable :

Numéro de téléphone résidentiel :

Numéro de téléphone professionnel :

Projet :

Dépenses fixes mensuelles totales : (RS)

Marque :

Email:

Modèle :

Date de naissance :

Capacité moteur :

État civil :

Marié Célibataire Divorcé

Année d'immatriculation du véhicule :

Nombre de dépendants :

Prix du véhicule : (RS)

Caution : (RS)

Durée du bail :

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