INTRODUCER/DEALER/BROKER DETAILS
Introducer Name/Company
Introducer Contact Person
Contact Phone Number
*Contact Email
FINANCE DETAILS
* These fields are required
*Loan Amount $
*Finance Type
*Term
APPLICATION DETAILS
Business Type
*Account Type
AUTHORISED SIGNATORY DETAILS
*Position Held
*Name of Government Dept
*Nature of Business
*Family-name
*First-name
Middle-name
*Gender
Current Residential
* Street-number
*Street-name
* Suburb
*State
*Post Code
*Drivers-license-number
*Date-of-birth
*Work Phone
Fax
*Mobile
Email
APPLICANT PARTNERSHIP DETAILS
*Occupation
*Name of Legal Entity in full
*ABN
*Suburb
*Years Trading
Years Months
*Previous Employer(if less than 3 years trading)
*Number of Employees
*Gross Profit $
*Gross Turnover $
SOLE TRADER/SELF EMPLOYED DETAILS
*Number Employees
*Gross Income $
EMPLOYED INDIVIDUAL
* Family-name
* First-name
* Gender
Male Female
* State
*Home Phone
*Fax
*Employer
*Years Employed
*Previous Employer (if less than 3 years trading)
*Gross Annual Salary$
* Drivers-license-number
* Date-of-birth
*Australian Company Number (ACN)
Turnover $
*Years under current owner
Net Profit $
*Name of Contact
*Position
*Office Phone
Office Fax
Office Email
ADDITIONAL DETAILS
*Accountant Company Firm Name
*Contact Person
*Phone Number
*Authority to contact your accountant for information if required
Yes No
*Trade Reference 1
*Reference Phone
*Trade Reference 2
PERSONAL DETAILS 1st PERSON
To be fully completed by directors/partners/individuals NOT required for government or top 500 companies
* Post Code
*Drivers License
*Date of Birth
*Annual Income
Are you a
Renter or Home Owner
*Value $
*Mortgage $
*Previous Address (if less than 3 years at current address)
Are There Any More Partners/Directors
PERSONAL DETAILS 2nd PERSON
*Address
*How long at current address
PERSONAL DETAILS 3rd PERSON
PERSONAL DETAILS 4th PERSON
PERSONAL DETAILS 5th PERSON
*Reason for Advance
*Details:
*Equipment Description
*Reason for Equipment
*Supplier of Goods
*Sales Person
* First Person
PRIVACY AND CREDIT INFORMATION & PRIVACY ACT AUTHORISATION/AGREEMENT
I/We certify that the equipment will be used predominantly for business or investment purposes.
* Second Person
* Third Person
* Fourth Person
* Fifth Person
*First Person
I agree
*Second Person
*Third Person
*Fourth Person
*Fifth Person