Gateway Motors Cebu, Inc.

Date ____________________

GATEWAY MOTORS CEBU INC

( NISSAN GLOBAL CITY BRANCH) Date: _______________

MP: ___________________ GRM _______________________

Contact # :____________________ Contact # _____________________

Unit/Model; _____________________ Down Payment _____________________

Selling Price: ____________________ Term ______________________

BORROWER

Name (Lastname, Firstname, Middle Name) Birthdate:

Complete Address: Civil Status:

Length Email Address:

___ Owned __Owned but mortgage __Rented
of Stay
Tin #: SSS #: Mobile #: Landline #

SOURCE OF INCOME
Name of Employer/Business: Years of Employment/Business

Complete Address: Income

Contact #: Email Address: Position

SPOUSE/CO-MAKER
Name (Lastname,Firstname, Middle Name) Birthdate

Complete Address Civil Status

__Owned __Owned but mortgage __Rented Length Email Address

of Stay
Tin # SSS # Mobile # Landline #

Relationship to Borrower

SOURCE OF INCOME
Name of Employer/Business N/A Years of Employment/Business

Complete Address Income

Contact # Email Address Position

SPOUSE/CO-MAKER
Name (Lastname,Firstname, M.I.) Birthdate

Complete Address Civil Status

__Owned __Owned but mortgage __Rented Length Email Address

of Stay
Tin # SSS # Mobile # Landline #

Relationship to Borrower

SOURCE OF INCOME
Name of Employer/Business N/A Years of Employment/Business

Complete Address Income

Contact # Email Address Position

BANK ACCOUNT REFERENCES

Bank Name Account Number Branch/Telephone Number

TRADE REFERENCES

Contact Person/Name of Trade Phone Number/Complete Address

PERSONAL REFERENCES

Name Address Phone Number

______________________ _____________________ ___________________

Prepared by: Sales Agent Noted by : Sales Manager Client Signature

AO Designated Area

CBS Alabang & Sucat - Ms. Aichie 9175630325

Dasma - Ms. Mhay - 09456704683
Carmona - Ms. Shiela - 09567092527