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
PARTNERSHIP
Occupation
Years Trading
Years Month
Previous Employer (if less than 3 years trading)
No of Employees
Gross Profit $
Gross Turnover $
SOLE TRADER/SELF EMPLOYED
Gross Income $
EMPLOYED INDIVIDUAL
Employer
Years Employed
Gross Annual Salary$
COMPANY
Nature of Business
Years est.
Turnover $
No of Emp.
Years under current owner
Net Profit $
Your trade references
Trade Reference 1
Reference Phone
Trade Reference 2
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
Address
Are you a
Renter or Home Owner
Value $
Mortgage $
Previous Address (if less than 3 years at current address)
Length in years
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
PERSONAL DETAILS 2nd PERSON
PERSONAL DETAILS 3rd PERSON
PERSONAL DETAILS 4th PERSON
PERSONAL DETAILS 5th PERSON
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
Second Person
Third Person
Fourth Person
Fifth Person
I agree