Logbook Loan Repeat Form

Full Names *

Phone *

Email Address *

KRA PIN *

ID Number *

Type of Income * Type of Income Business Salaried

Nature of Business

What is your estimated Monthly Revenue *

Vehicle Make *

Vehicle Model *

Year of Manufacture *

Loan Period (1-24 months) * Select… 1 Month 2 Months 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10 Months 11 Months 12 Months 13 Months 14 Months 15 Months 16 Months 17 Months 18 Months 19 Months 20 Months 21 Months 22 Months 23 Months 24 Months

Loan Amount *

Loan Purpose

Referral Person