Ololo Express Hire Purchase Customer Registration Form

SECTION 1: PERSONAL INFORMATION

Full Name

Date of Birth

Gender

[radio* gender use_label_element id:gender "Male" "Female" "Other"]

Nationality

Residential Address

City/Town

Region

Email Address

Mobile Number

Alternative Contact Number

National ID Type
PassportVoter’s IDDriver’s LicenseGhana Card

National ID Number

SECTION 2: EMPLOYMENT DETAILS

Employment Status

[radio* employment-status use_label_element id:employment-status "Salaried" "Self-Employed" "Unemployed"]

Occupation

Employer’s Name

Employer’s Address

Work Phone Number

Monthly Salary (GHS)

SECTION 3: FINANCIAL DETAILS

Mode of Payment

[radio* payment-mode use_label_element id:payment-mode "Bank" "Mobile Money" "Cheque"]

Bank Name

Bank Account Number

Mobile Money Network
MTNVodafoneAirtelTigo

Mobile Money Number

Last 3 Months’ Bank/Mobile Money Statement Submitted?

[radio* statement-submitted use_label_element id:statement-submitted "Yes" "No"]

Recent Pay Slip Submitted?

[radio* payslip-submitted use_label_element id:payslip-submitted "Yes" "No"]

SECTION 4: GUARANTOR DETAILS

Guarantor Full Name

Relationship to Buyer

Residential Address

City/Town

Region

Mobile Number

Alternative Contact Number

National ID Type
PassportVoter’s IDDriver’s LicenseGhana Card

National ID Number

Guarantor’s Passport Photo Submitted?

[radio* guarantor-photo-submitted use_label_element id:guarantor-photo-submitted "Yes" "No"]

SECTION 5: PRODUCT DETAILS

Product Name

Product Model

Product Price (GHS)

Payment Plan Selected

Full Amount (3 Months)Full Amount (4 Months)50% Upfront (3 Months)50% Upfront (4 Months)

SECTION 6: AGREEMENT & DECLARATION

Terms and Conditions

I have read and agree to the Terms and Conditions of Ololo Express Hire Purchase.