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 YOUR  DEALER AND PURCHASE

YOUR  DEALER

BRIEF DESCRIPTION
OF GOODS

PRICE INC G.S.T

DEPOSIT AMOUNT

DEPOSIT AMOUNT

TERM REQUIRED

 CONTACT DETAILS

WORK PHONE NO

LEGAL NAME

COMPANY NUMBER

PHYSICAL ADDRESS

POSTAL ADDRESS

WORK FAX NO

TRADING NAME

I.R.D. NUMBER

PHYSICAL CITY

E-MAIL ADDRESS

 GENERAL BUSINESS INFORMATION

TYPE OF BUSINESS

TOTAL YEARS TRADING

NO OF EMPLOYEES

BUSINESS ESTABLISHED

BUSINESS PREMISES

BANK MANAGER’S NAME

BANK MANAGER’S PHONE

ACCOUNTANT’S NAME

 TRADE REFERENCES

BUSINESS NAME 1

BUSINESS NAME 2

ACCOUNTANT’S PHONE

PHONE NUMBER

PHONE NUMBER

PRINCIPAL OF BUSINESS 1 - (Shareholder / Director)  “Small to Medium size Business”

FULL NAME

HOME ADDRESS

HOME CITY

 YOUR ASSETS

HOME VALUE  (Approx)

CAR VALUE  (Approx)

INVESTMENTS  (Approx)

DATE OF BIRTH

SUBURB

TIME THERE IN YEARS

 YOUR LIABILITIES

1ST MORTGAGE  (Approx)

CAR FINANCE BAL  (Approx)

CREDIT CARD LIMITS  (Approx)

HOME PH NO

MOBILE PH NO

PRINCIPAL OF BUSINESS 2 - (Shareholder / Director)  “Small to Medium size Business”

FULL NAME

HOME ADDRESS

HOME CITY

 YOUR ASSETS

HOME VALUE  (Approx)

CAR VALUE  (Approx)

INVESTMENTS  (Approx)

DATE OF BIRTH

SUBURB

TIME THERE IN YEARS

 YOUR LIABILITIES

1ST MORTGAGE  (Approx)

CAR FINANCE BAL  (Approx)

CREDIT CARD LIMITS  (Approx)

HOME PH NO

MOBILE PH NO

Credit Reporting Privacy Code 2004

I hereby authorise any person or company to provide you or Credit Capable Limited with such information as you may require in response to your enquiries associated with this application. I also further authorise you to furnish to any third party or parties details of this application and any subsequent dealings that I may have with you as a result of this application being actioned by you. I hereby declare that the information provided is true and correct and that I am not an undischarged bankrupt. I agree that the financier may nominate the insurer at its discretion. I understand that Credit Capable Ltd have asked me for personal information about me so as to use Veda Advantage's credit reporting service to credit check me. I understand that:

Veda Advantage will give you information about me for that purpose. You will give my personal information to Veda Advantage, and that Veda Advantage will hold that information on their systems and use it to provide their credit reporting service. When other Veda Advantage customers use the Veda Advantage credit reporting service, Veda Advantage may give the information to those customers. If I default in my payment obligations to you, information about that default may be given to Veda Advantage, and Veda Advantage may give information about my default to other Veda Advantage customers.

ACCEPTED

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