Flexirent Ireland Online Application Form

Flexirent Ireland Online Application Form
Are you over 18?*

Yes
How long have you lived in Ireland?*

1-3 years3-5 years5-10 yearsI was born in Ireland
Are you a previous customer of Flexirent?*

YesNo
Equipment type*

Computer / TechnologyElectrical / AppliancesOther
Equipment Price*
Your Name*

First NameLast Name
Your Gender*

MaleFemale
Your Date of Birth*

DayMonthYear
Your Address*

Street Address

Street Address Line 2

CityCounty

Post CodeCountry
Length of stay at current address (in years)*
What is your current residential status?*

Owner OutrightMortgagorRentingLiving with ParentsBoarding
Do you have any other Outgoings?*

Retail FinanceCar LoanPersonal LoanBusiness LoanNone of the above
Your Mobile Phone*

Area CodePhone Number
Your Home Phone

Area CodePhone Number
Your Email*
Your Employment Status*

StudentFull TimePart TimeSelf EmployedNot EmployedOther
Your Income*

€0 - €12,000€12,000 - €20,000€20,000 - €30,000€30,000 - €45,000€45,000 +
Is Your Income Taxable?*

YesNo
Preferred Contact Date*

DayMonthYear
Preferred Contact Time*
How did you hear about Flexirent?*

In StoreOnlineOn this SiteDirect MailPrint AdvertisingWord of Mouth
I consent to Flexirent giving to and seeking from credit reporting agencies, including the Irish Credit Bureau, and other credit providers named in reports from those agencies, information about my personal and commercial activities and credit worthiness

I Agree
Copy of Photo ID*

Upload a File
Accepted file types: jpg, png, pdf Cancelof
Copy of Utility Bill*

Upload a File
Accepted file types: jpg, png, pdf Cancelof
Should be Empty: