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VEHICLED DETAILS Manufacturer: Make: Model: SELECT FROM THE FOLLOWING 2 Door 4 Door 2WD CD Player Sunroof Security Alarm Cruise/Speed Control Leather Interior 5 Passenger 7 Passenger Other Information? Purchase Mode: Finance Lease Purchase Terms: 24 Months 36 Months 48 Months Preferred Date Vehicle Needed (MM/DD/YY) Location for Delivery CONTACT INFORMATION *First name: *Last name: Salutation: *Email address: Current Location: PHILIPPINES CANADA UNITED STATES Best Phone Number To Contact You: Any Other Phone Number: Date You Would Like to be Contacted: Time (am/pm) You Would Like to be Contacted: Name of US Employer: US City/State: Employer's Phone Number: Employer's Email Address: Name of Recruitment Agency: Hourly Pay Rate (Salary rate per hour in $US) Do You Know How to Drive? Yes No Do You Possess a Drivers License? Yes No Does Your Spouse Know How to Drive? Yes No Does Your Spouse Possess a Drivers License? Yes No Did You Take A Driving Lesson? Yes No Did Your Spouse Take A Driving Lesson? Yes No Note: All Information herein is confidential. HRPC agrees that it will not make use of, reproduce, disseminate or in any way disclose to any person, firm or business, any confidential information of the disclosing party except to the extent necessary for negotiations, discussion, and consultations with personnel or authorized representatives of AutoSource International.