Need any help? Phone: 01332 321702 Email: kimberley.parker@henryscheinfinancial.co.uk
KavoKerr Finance Application Reference:
Date submitted:
/
/
Submitted by:
Partner 1:
GDC No.:
Date of birth:
/
/
Partner 2:
GDC No.:
Date of birth:
/
/
Partner 3:
GDC No.:
Date of birth:
/
/
Trading style:
Sole trader
Partnership
Limited company - your company registration number is:
Website address: Trading name:
Net value (before VAT):
Address:
Finance amount: Postcode:
Year established:
Telephone:
Finance term:
12 months @ 0%
Equipment to be purchased:
Email:
Finance agreement to be sent via e-signature when invoiced, please use a business or personal email with director/partners name e.g. j.smith@gmail.com / john.smith@dentalpractice.co.uk If unavailable, use your preferred personal/business email and in this instance, you’ll be required to print, sign and return the finance agreement as we cannot send via e-signature.
Partner 1: Home address
Kavo Kerr bundle
Note bundle:
Partner 2: Home address
Partner 3: Home address
House number or name:
House number or name:
House number or name:
Street:
Street:
Street:
Town/City:
Town/City:
Town/City:
Postcode:
Postcode:
Postcode:
Telephone:
Telephone:
Telephone:
Email:
Email:
Email:
How many years have you lived here?*
How many years have you lived here?*
How many years have you lived here?*
* If less than 3 years, supply full previous address:
* If less than 3 years, supply full previous address:
* If less than 3 years, supply full previous address:
Partner 2: Authorisation
Partner 3: Authorisation
Partner 1: Authorisation Date:
/
/
Date:
/
/
Date:
/
Print name:
Print name:
Print name:
Signature:
Signature:
Signature:
/
If you require Henry Schein to speak with a contact person on your behalf about your finance application, please tell us here: I authorise Henry Schein to discuss my financial agreement on my behalf with: Name:
Position:
Not applicable:
Please email this completed application to: kimberley.parker@henryscheinfinancial.co.uk and lucy.keeble@henryscheinfinancial.co.uk Alternatively, post to the address shown below. Henry Schein Financial Services is authorised and regulated by the Financial Conduct Authority only in respect of agreements regulated by the Consumer Credit Act 1974. By providing the details requested you give Henry Schein Financial Services permission to process a finance application with their finance providers and credit checks which may involve passing your personal details to more than one funder. First Floor, Pacific House, Stanier Way, Wyvern Business Park, Derby, DE21 6BF A division of Henry Schein UK Holdings Ltd. Registered number: 11584480
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HSUK002-01-19 Equipment
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