Apply for Finance

I am over 18 years of age*
Title*
Name*
Surname*
Date of Birth*
Place of Birth*
Marital Status*
Phone Number*
Email*
Residential Status*
Home OwnerLiving With ParentsTenant
Address*
Time at Address*
Previous Address (if less than 3 years at current address)
Employment Type*
PermanentTemporaryContract
Occupation*
Employer Name*
Employer Address*
Time with Employer (Years/Months)
No. of Dependent Children*
Weekly Take Home Pay*
Other Income (per month)
Past Employment (enter if less than 3 years in current position)
Past Employer's Name
Past Employer's Address
Past Employment Duration
Bank*
Branch*
Time with Branch*
Car Details
Car*
Registration of Trade in
Mileage of Trade in
Finance Term
Comments
I consent to receive marketing communication from O'Briens Kilkenny
NoYes
Data Protection and Consents

The information that you provide on this proposal form will be forwarded to one or more financial institutions, being members of the Irish Finance Houses Association, and will be used by them for the purposes of assessing the suitability for you of their finance products, potentially offering you a product or a quote. As part of this process, credit searches will be made with one or more credit reference agencies, including the Irish Credit Bureau (ICB), which will make a record of the search. Details of any agreement you enter into, and your conduct of that agreement, may be shared with the credit reference agencies, ICB and their members. Searches may also be carried out to verify your identity, and you may be contacted directly (including by telephone) for the purposes of verifying the information on this form. Credit scoring and other automated decision-making process may be used.

By ticking the consent box below, I certify that I consent to the use and disclosure of this information for the purposes set out above. I acknowledge that the recipients of this information are authorised to contact me and to disclose any material misstatements of fact on this proposal to their members and other relevant bodies.

I have read and consent to the above*