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To get started, just complete our secure online finance application. We'll help you get pre-approved, making it even easier for you to shop for your next vehicle.

Contact Info

Primary Applicant

First Name

Last Name

Middle Initial

Date of Birth

Private Tel

Mobile Tel

Work Phone

Email Address

Address Line 1

Address Line 2

City

Country

Monthly Payment Commitments

Vehicle and Financing Requirements

Vehicle Info

Purchase TypeNew Purchase New Lease Pre-Owned Purchase

Year

Make

Model

Number of Vehicles

Colour

Fuel Type

Transmission

Wheel Drive

Date of First Regn

VIN no.

Engine Size

Approximate Price

Loan Amount

Financing Requirements

Auto Loan

Deposit/Trade-in provided

Estimated Finance required

Auto Lease

Monthly lease payment budget

Mileage estimate per annum (Kilometers)

Trade-In

Trade-In?Yes No

Supporting Information

Residency StatusSamoan Citizen Samoan Permanent Resident

Marital StatusSingle Married Divorced Widowed

No. of Dependent Children

Country of Domicile

Rent or Own?Rent Own

Landlord's Name

Landlord's Address

Previous Address

Date Occupied

Date Moved

Nearest Relative (not living with me)

Relationship to Relative

Relative's Address

Relationship to Relative

Relative's Tel

Income Info

Employer Name

Job Title

Employer's Address Line 1

Employer's Address Line 2

Employer's City

Employee Since

Previous Employer's Address Line 1

Previous Employer's Address Line 2

Previous Employer's City

Employee Since (Previous Job)

Monthly Income (Net)

Monthly Outgoings

Spouse's Occupation

Spouse's Date of Birth

Spouse's Monthly Income (Net)

Spouse's Monthly Outgoings

Additional Income Source

Additional Monthly Income

Further information

Please answer the following:

I have explained my financing and/or leasing and budgetary requirements and have selected the alternative that best meets my needs. If No, please explain why below.Yes No

I am not currently, nor have ever been bankrupt or have undisclosed debt elsewhere. If False, please detail the circumstances below.True False

I have no history of loan defaults. If False, please detail circumstances below.True False

Privacy Statement Please review the following privacy statement before submitting your application:

Guiding Principles:

In connection with your transaction, Ford Hyundai Samoa may acquire information about you as described in this notice, which we handle as stated in this notice.

We may collect personally identifiable information such as name, postal address, telephone number, e-mail address, date of birth, etc. This personal information is collected and used by Ford Hyundai Samoa staff for the purpose of facilitating a relationship or business transaction.

Our website resides behind a firewall and uses SSL (Secure Sockets Layer, the industry-standard security protocol used to communicate with browsers) to transmit personal information. Data is strongly encrypted during transmission to ensure that personal and payment information is secure. Industry-standard data encryption techniques are used to protect personal information.

The Applicant(s) certify that the above information is true, complete and correct and that they have read and understood the provisions contained in this application. The Applicant(s) authorise (s) Federal Pacific Auto Finance to make any enquiries or take any references that are deemed appropriate in the consideration of this application including the Applicant(s) present employer.

I agree to give permission for the above applicant(s) Consumer Credit Report(s) be obtained, at no cost to me, in order to help determine the types and extent of financing which are available:

Ford Hyundai Samoa does not sell, rent or disclose e-mail addresses to other organizations.