Brendan Foot Supersite - Personal credit application form

Contact

To discuss your vehicle finance or lease needs, please contact our Business Manager:

P: 04 587 0005
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Credit Application

Complete our confidential online Personal Credit Application for pre-approval, or our Company Credit Application.

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Personal credit application form

Applicant:	Invalid Input	Invalid Input
Marital Status:	Invalid Input	Number of Dependants:Invalid Input
Spouse's Name:	Invalid Input	Invalid Input
Date of Birth:	Invalid Input	Invalid Input
Driver's Licence No:	Invalid Input	Invalid Input

Current Address:	Invalid Input
Years At Address:	Invalid Input
Tenancy:	Own House Renting Boarding Family House Other Invalid Input
Other (Detail):	Invalid Input
Previous Address:	Invalid Input
Years At Address:	Invalid Input
Email Address:	Invalid Input

Phone:

Invalid Input Invalid Input Invalid Input

Present Employer:	Invalid Input	Years:	Invalid Input
Address:	Invalid Input	Occupation:	Invalid Input
Previous Employer:	Invalid Input	Years:	Invalid Input
Spouse's Employer:	Invalid Input	Years:	Invalid Input
Address:	Invalid Input	Occupation:	Invalid Input

Parents Name/Nearest Relative:	Invalid Input
Address:	Invalid Input
Relationship:	Invalid Input

Account References:	(1)	Invalid Input
	(2)	Invalid Input

Bank:

Invalid Input

Account No:

Invalid Input

Approximate Amount Required: $ Invalid Input

Assets	(please note all assets which are jointly owned)	Joint	Liabilities
Home	$ Invalid Input	JointInvalid Input	Mortgages	$ Invalid Input
Furnishings	$ Invalid Input	JointInvalid Input	HP/Credit Accounts	$ Invalid Input
Bank	$ Invalid Input	JointInvalid Input	Bank O/D	$ Invalid Input
Car	$ Invalid Input	JointInvalid Input	Other Creditors, Loans	$ Invalid Input
Investments	$ Invalid Input	JointInvalid Input
Other	$ Invalid Input	JointInvalid Input

TOTAL	$ Invalid Input		TOTAL	$ Invalid Input
Net Worth	$ Invalid Input

Income (monthly)		Expenses (monthly)
Average Take Home Pay	$ Invalid Input	Mortgages/Rent Payments	$ Invalid Input
Spouses Take Home Pay	$ Invalid Input	HP And Credit Accounts	$ Invalid Input
Other Income	$ Invalid Input	Rates, Phone, Power, Insurance	$ Invalid Input
		Life Insurance/Building Society	$ Invalid Input
		Car And Other Expenses	$ Invalid Input

TOTAL	$ Invalid Input	TOTAL	$ Invalid Input

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
Invalid Input
If yes, please state details:
Invalid Input

x I apply for a loan and certify that the particulars above and overleaf are true and correct and that I am over the age of 18 years and am not an undischarged bankrupt. 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 (both now and in the future) 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 agree that the information in connection with this finance application may be transmitted via facsimile and/or electronic mail, and I acknowledge that there may be some security risks associated with the transmission.

I have read and accept the terms and conditions within this informative statement/authorisation.

Yes
Invalid Input

I Accept Terms And Conditions

Please ensure the details you have provided above are correct before submitting the application.