Apply for Finance

Applicant First Name:*
Applicant Last Name:*
Applicant Date of Birth:*
Applicant Company Name
Current Address:*
Current Suburb:*
Current City:*
Years At Current Address:*
Years At Previous Address:
No. of Dependants:*
Marital Status*
Residential Status*
Previous Address:(if less than 3yrs)
Previous City:
Nearest Relative (NOT LIVING WITH YOU)
Relative Name:*
Relative Address:*
Relative Phone:*
Relationship:*
Occupation:*
Years in Current Role:*
Current Employer:*
Current Employer Address:*
Permanence:*
Previous Employer:(if less than 3yrs)
Spouse Occupation:
Spouse Years in Current Role:
Spouse Employer:
Spouse Employer Address:
Years in Previous Role:
Applicant Licence Number (5a):*
Applicant Licence Version (5b):*
Spouse Licence Number (5a):
Spouse Licence Version (5b):
Applicant Licence Type:*
Expiry Date:*
Assets
Property ($):
Furnishings/Contents ($):
Bank ($):
Vehicle ($):
Investments/Kiwisaver/Other ($):
Income (Monthly)
Average Net Income ($): after tax
Spouse's Average Net Income ($): after tax
Other Income ($):
Liabilities
Mortgages ($):
Hire Purchase/Credit Accounts ($):
Bank Overdraft ($):
Other Creditors/Loans ($):
Expenses (Monthly)
Mortgages/Rent Payments ($):
Hire Purchase/Credit Accounts Payments($):
Rates, Phone, Power, Insurance ($):
Vehicle/Other Expenses ($):
Contact Details
Contact Phone:*
Mobile Phone:*
Email:*
Preferred Contact Method

We may require further information for your application - what is the best way to contact you?

Contact Phone
Mobile Phone
Email
Are you aware of any previous or current default or credit issues?
Yes
No
What is your preferred payment time of instalments
Weekly
Fortnightly
Monthly
Other Information

If necessary, please provide us with any other information that will assist your application.*

Please specify:
Terms and Conditions
I have read and accept the conditions:*
Yes