Contract Car Hire Application

To make an online Car Hire Application, complete and send the form below.
If you have any queries regarding your application, call us and we will be pleased to assist you. On receipt of your application, a representative from Go Instruct will contact you.

To make a postal Car Hire Application, print the PDF form, fill it in and send it to:
Go Instruct Car Hire, Unit 15 Hurlston Court, Scarisbrick Business Park, Scarisbrick L40 8HN

DOWNLOAD — PDF Car Hire Application Form

Contract Car Hire Application Form
Your Details
Title
First Name
Last Name
Home Phone
Mobile
Email
Date of Birth (dd/mm/yyyy)
Current Address

Town
County
Postcode
Time at Current Address	Years Months
Residential Status
Dependents under 18	enter '0' if none
Marital Status
Driver License Number
Are you a DSA ADI or PDI?
DSA ADI or PDI Ref Number
Length of time ADI or PDI	Years Months
Complete if less than 3 years at Current Address
Previous Address

Town
County
Postcode
COUNTRY

Employment Details
Occupation
Employment Status
Employer (Company Name)
Work Address

Town
County
Postcode
Work Phone
Time with Employer	Years Months
If on a Fixed Contract (time completed)	Years Months
NOTE: Your employer will not be contacted without your permission.
Complete if less than 3 years in Current Position
Previous Occupation
Previous Employment Status
Employer / Company Name
Time with Previous Employer	Years Months

Bank Details
Bank Name
Time with Bank Years Months	Years Months
Payment Method First Month (tick)	Debit/Credit Card
Payment Method Remainder (tick)	Direct Debit
NOTE: The payment method for all Go Instruct car hire contracts is by Direct Debit, apart from the first installment which can be paid by Debit or Credit Card.

Customer Notification
The information that you have provided on this form will be disclosed to lenders for the purpose of considering this credit application. Lenders may use this information to carry out searches with credit reference agencies. A record of those searches will be kept and may be used by other lenders in accessing applications from you and members of your household for credit in the future. Lenders will cross-check this information with other lenders to prevent fraud and may use the information for statistical or marketing purposes. I have read the customer notification and I accept that the information I have provided will be used for the purpose of considering this credit application (tick to accept).

Vehicle Requirement
Make
Model
Trim
Engine Size (litre)
Reset Vehicle Make, Model, Trim Requirements
Gearbox
Fuel Type
Number of Doors
Other Requirements
Vehicle Colour Preference First Choice
Second Choice
Third Choice
Period of Lease
New or Used (New Cars not available on a GoFlex contract)
Date Vehicle Required (dd/mm/yyyy)

Customer Declaration
I wish to lease a vehicle from Go Instruct Car Hire with requirements as above (tick)
I agree to pay the Administration Fee of £45 inc VAT (tick)	Debit / Credit Card
To make your credit card payment: Call Go Instruct Car Hire during office hours on 01704 84 06 09 to give us your card details.
How did you find out about us? Please check the details are correct and enter the words in the box before you click 'Send Application'.