First Name
Last Name
Phone Number
Phone Number (other)
Email Address
Address
Purpose of Loan
  • - select purpose -
  • Personal
  • Business
  • Education
  • Home purchase
  • Car
  • Investment
  • Wedding
  • Home Renovations/ Repair
  • Travel
  • Debt consolidation
  • Personal Expenses
Name of Automobile Company
Name of Salesperson
Contact of Salesperson
Preferred Branch
  • - select your preferred branch-
  • Akontombra
  • Adabokrom
  • Asempaneye
  • Asankragua
  • Adum
  • Asokwa
  • Adabrakra
  • Abossey Okai
  • Agona Swedru
  • Asamankese
  • Adjiringanno
  • Ashaiman
  • Accra Central
  • Accra NewTown
  • Achimota
  • Bolgatanga
  • Baatsonaa
  • Cape Coast
  • Community 25
  • Dansoman
  • Essam
  • Ebankese
  • Kumasi Main
  • Goaso
  • Juaboso
  • KNUST
  • Kumasi Suame
  • Kasoa
  • Koforidua
  • Legon (University)
  • Labone (Private Banking)
  • Madina
  • Ridge
  • Sefwi Wiawso
  • Sefwi Bekwai
  • Techiman
  • Tamale
  • Tema
  • Takoradi
  • Tudu
Employer
Salary Range
  • - select range-
  • GH₵ 500 - GH₵2999
  • GH₵ 3000 - GH₵5000
  • GH₵5000- GH₵7500
  • GH₵7500- GH₵10000
  • GH₵10000- GH₵15000
  • GH₵15000- GH₵20000
  • over GH₵20000
Comments
How did you first hear of this loan product?
  • - select channel -
  • Individual
  • channel
Name (optional)
Phone Number (optional)
please specify