Personal Information
Repeat Customer?
Yes
No
First Name:
Middle Name:
Last Name:
Gender:
Male
Female
Marital Status:
Single
Married
Divorced
Separated
Widowed
Nationality:
Filipino
Others
Contact Number #1:
Contact Number #2: (Optional)
Birth Date:
Province
Municipality:
Barangay:
House No, Street
Type of Residence:
Owned
Rented
Mortgaged
Other
Length of Stay
< 1 Year
1 to 3 Years
3 to 5 Years
Over 5 Years
Since Birth
Customer Source of Income
Source of Funds:
Select Source of funds
SELF-EMPLOYED/BUSINESS
EMPLOYED
ALLOTMENT
PROVIDED BY OTHERS
Occupation
Employer/Business Name
Address
Upload proof of income/remittance: (Optional)
Upload Valid ID:
Unit Information
Category:
Motorcycle
Appliance
Power Product
Pre-owned Motorcycle
Pre-owned Appliance
Brand:
Model: (If not familiar, please specify.)
Downpayment
Terms:
3 months
6 months
12 months
18 months
24 months
30 months
36 months
Preferred Branch:
I authorize Premio Finance Corporation, Desmark Corporation, Premio Corporation and its representatives to perform credit inquiries and verify data submitted herein.
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