Please complete the following application on-line and then print it out, or you can print it out first and then fill it in.
Please sign the completed form and fax it to us on (03) 341 7720.
Surname Marital status  
First Names Dependants (No.)
Street Dependants (ages)
Suburb Occupation
City Employer & Address  
Post code
Home phone How long employed  
Work phone Previous employment
Mobile phone Nearest relative
Date of birth Relative's address
Drivers license No.

  If second applicant is a joint applicant

 Relative's relationship
Date of birth Credit reference
Drivers license No. Bank and branch
  Residence      
Current residence Previous address 
(if less than 3 yrs) 
How long at current residence (years) How long at previous residence (years)
  Assets   Liabilities
Home $ Mortgage/rentals $
Vehicles $ Hire purchase $
Furniture & Effects $ Other loans $
Bank $ Credit cards $
Investments $
Other $
  Income      
Take home pay $   per week   fortnight   month   annual
Spouse $   per week   fortnight   month   annual


I apply for a loan and certify that the particulars above are true and correct. Pursuant to the Privacy Act 1993, I authorise any finance company to contact any credit reporting agencies, credit providers, my employer(s), accountant(s), or any other source to obtain, check, and exchange such personal, financial, and commercial information and references about me/us as is necessary for the purposes of considering this application, the protection and administration of any loan arising out of this application, and to assist in the enforcement of any agreement between me/us, and any finance company. I agree that you may produce this authority to such parties for the purposes of collecting such information. Under the provisions of the Privacy Act 1993, you are entitled to have access and request correction to personal information held about you. I have read and accept the terms and conditions within this informative statement/authorisation.

I ACCEPT THESE TERMS AND CONDITIONS           Applicant's signature _______________________________________

                                                                                          Date _______________________________________
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