Vehicle of interest (optional)
Vehicle Interested In
Stock Number
Yard
Amount Required
Applicant Details
(surname)
(christian names)
(Date of Birth)
(Drivers license No. - 5A)
(Version Number - 5B)
Marital Status
*
Never Married
Married
Widowed
Divorced
Number of Dependants
*
Spouses Details
(surname)
(christian names)
(Date of Birth)
(Drivers license No. - 5A)
(Version Number - 5B)
Contact/Address Details
Current Address
*
Previous Address
Years at Address
*
Years at Address
Tenacy
*
Own House
Renting
Boarding
Family House
Other
Detail
(if "Other" selected)
Email Address
*
Phone numbers
*
(Private)
(Business)
(Mobile)
Employment Details
Present Employer
*
Spouse's Employer
Years
*
Years
Address
*
Address
Occupation
*
Occupation
Employer Phone Number
*
Previous Employer
Years
Reference Details
Parents Name/Nearest Relative
*
Account Reference (1)
*
Address
*
Account Reference (2)
Relative Phone Number
*
Bankers
*
Relationship
*
Account No.
*
Asset & Liability Details
Assets
(please tick all assets
which are jointly owned)
Liabilities
Home
$
Mortgages
$
Furnishings
$
Credit Contracts/
Credit Accounts
$
Bank
$
Bank O/D
$
Car
$
Other Creditors,Loans
$
Investments
$
Other
$
Total
$
Total
$
Net Worth
$
Income & Expense Details
Income
(monthly)
Expenses
(monthly)
Average take home pay
$
Mortgages/
Rent payments
$
Spouse's take home pay
$
Credit Contracts/
Credit Accounts
$
Other income
$
Rates, Phone,
Power, Insurance
$
Life Insurance/
Building Society
$
Total
$
Car and other expenses
$
Total
$
Information Statement / Authorisation Pursuant To The Privacy Act 1993
Please read this statement / authorisation notice in full
Have you ever had or are there now any attachments or legal proceeding against you, or any action for payment default?
*
Yes
No
If yes, please state details
I have read and accept the
terms and conditions
within this informative statement/authorisation.
I Accept Terms And Conditions
*
*
= Mandatory