ONLINE APPLICATION FORM

TYPE OF BUSINESS

* These fields are required

Proprietary Limited (Pty. Ltd)

Government

Partnership

Sole Trader/Self Employed

Employed Individual


APPLICANT'S DETAILS

*APPLICANT (Name of legal entity in full)

ABN (If Applicable)

Contact details

* Address

* Line2

* Post Code

* Work Phone

Fax

Mobile

*Home Phone

Email

Information about your Accountant

Accountant

Phone

Contact Person

* Authority to contact your accountant for information if required

 

  Yes          No

COMPANY

Nature of Business

Years est.

Turnover $

No of Emp.

Years under current owner

  Years    Month

Net Profit $

   

Your trade references

Trade Reference 1

Reference Phone

Trade Reference 2

Reference Phone

PERSONAL DETAILS – 1st PERSON

To be fully completed by directors/partners/individuals NOT required for government or top 500 companies

Full Name

Date of Birth

Drivers License

Phone Number

Annual Income

Time at current residence

  Years      Month

Address

Are you a

Renter  or Home Owner

Value $

Mortgage $

Previous Address
(if less than 3 years at current address)

Length in years

  Years      Month

Landlord/Mortgagee

Landlord/Mortgagee Contact

What current credit cards do you hold

Credit Card Types

 Master Card

 

 Amex

 

 Diners

 

 Bankcard

 

 Visa

If Other please specify Card Types


Are There Any More Partners/Directors

Yes    No  


SUPPLIER OF GOODS

Supplier of Goods

Equipment Description

Reason for Equipment

*Sales Person

*Phone Number

*Fax Number

*Amount $

*Term


PRIVACY AND CREDIT INFORMATION & PRIVACY ACT AUTHORISATION/AGREEMENT

I/We certify that the equipment will be used predominantly for business or investment purposes.

* First Person

Yes      No  


* First Person

I agree

Yes