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For LTD Company, Trust, Club/Society and Educational applications.

 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

I/We hereby authorise any person or company to provide you or the Company named above with such information as you may require in response to your inquiries associated with this application. I/We also further authorise you to furnish to any third party or parties details of this application and any subsequent dealings that I/We may have with you as a result of this application being actioned by you. I/We hereby declare that the information provided is true and correct and that I/We are not an undischarged bankrupt.
II/We agree that the financier may nominate the insurer.

ACCEPTED
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