Ind-AP-Header4

For new Applications and requested Guarantors who are over 18 YEARS OLD or in business Trading As.

To view this page correctly make sure your Text Size = Medium.   Use your TAB Key or Mouse to move between fields. (NOT ENTER)

 DEALER

 PURCHASE

Dealer Name :

Price Including G.S.T. :

Dealer Phone :

Order / Quote Number :

Sales Person Name :

Description of Goods :

Sales Person E-Mail :

 FINANCE

Deposit Amount :

Term Required :

Deposit Specified :

Payment Frequency :

 IDENTIFICATION

Given Names :

Spouses Occupation :

Surname :

Spouses Work PH :

Citizenship :

Home Address :

If NOT state citizenship :

Home Suburb :

D.O.B.  =  DD/MM/YYYY :

Home City :

Marital Status :

Dependants :

Years at Home Address :

E-Mail :

Previous Address :

Home Ph :

Previous Suburb :

Mobile Ph :

Previous City :

Name of Spouse :

Years at Prev Address :

Years lived in N.Z. :

 EMPLOYMENT

Occupation :

Business Name :

Supervisor’s Name :

Years at Current Work :

Weekly Income :

Previous Employer :

Work Ph :

Time there in Years :

Previous Work Ph :

 FINANCIAL INFORMATION

Vehicle Owner :

................................................................................................Value of Vehicle (Approx ) :

Home Owner :

.......................................................................................Value of Home or Land (Approx) :

Electrical Equipment :

....................................................................................(TV / Stereo / Computer)  (Approx) :

Vehicle Financed :

....................................................................................Vehicle Finance Balance (Approx) :

Home / Land Mortgage :

.........................................................................Home / Land Mortgage Balance (Approx) :

Elect Equip Financed :

...............................................................Electrical Equipment Finance Balance (Approx) :

Credit Reference 1 :

Contact Ph No :

Credit Reference 2 :

Contact Ph No :

Credit References are companies you have or had finance with, or service companies you hold accounts with. (EG power, phone, or gas)

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

If you have a current Drivers. (I.D. Requirements)

Drivers License Number :

Drivers License Version No :

(Look for 5b on the card)
AP-Footer