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800 Ipswich Rd. Annerley Qld 4103
ABN: 28 125 944 372
CREDIT APPLICATION FORM
Loan Purpose:
Enter why you require the loan
(i.e to purchase a car for transport to & from work)
Amount:
Enter the amount you wish to loan
(i.e $5,000)
CREDIT TERMS UP TO 24 MONTHS
Title:
Select
Mr
Mrs
Miss
Ms
Select your prefered title
Marital Status:
Select
Married
Single
Children:
Select
0
1
2
3
4
5
6
7
8
9
10
Surname:
Given names:
License No.
Drivers license no.
(this is found at the Top Right hand side of your license)
Date of Birth:
Day
for ($i = 1; $i < 32; $i ++) { echo "
$i
"; } ?>
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
for ($i = date("Y") - 15; $i > date("Y") - 100; $i --) { echo "
$i
"; } ?>
Home Phone:
Work Phone:
Mobile Phone:
Current Address:
Current Address
The address where you are living at the moment.
Postcode:
How long have you lived at the above address?
Are you Renting, Buying or Boarding?
Select
Renting
Buying
Boarding
Select Renting, Buying or Boarding
Note: If you select Renting OR Buying please enter the Landlord or Mortgagee name and phone number in relevent box below.
Landlord or Mortgagee:
Phone:
Previous Address
Previous Address:
Previous Address
The last address you used to live at.
Postcode:
How long did you live at the above address?
Employment
Occupation:
Current Employer :
Phone:
How long:
Wages:
Previous Employer :
Phone:
How long:
Wages:
Other income:
Any other income
Enter any other income you have besides your current job
Credit History
Current Loans :
Previous Loans :
Weekly Expenditure
Rent / Mortgage :
$
Food:
$
Phone:
$
Loans
:
$
Other Expenditure:
$
Total:
$
TOTAL
This figure is calculated Automatically as you fill in the weekly expenditure amounts above.
Nearest Relative
Name & Address of nearest relative
NOT
living with you:
Phone:
Mobile:
Name, Address & Phone No's of Three (3) friends
Friend 1 Address:
Phone:
Mobile:
Friend 2 Address:
Phone:
Mobile:
Friend 3 Address:
Phone:
Mobile:
Security check:
(
enter the Code as shown below)
Code:
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to read the Privacy Agreement)