Online Credit Application

Full Name: *	First, Middle, Surname	Date of Birth:*
Partners Full Name:	First, Middle, Surname	Date of Birth:
Current Address:	House No, Street, Suburb	City:
Phone:		Years There:
E-mail:*		Tenancy:
Marital Status:		Previous Address:	House No, Street, City
No. of Dependents:
Drivers Licence No:		Insurance Company:

Occupation:		Mobile Phone No:
Employer:		Years There:
Address:		Phone No:

Partners Employer:		Work Phone No:
Work Address:		Occupation:
Years There:

Parents Name:		Address:
Phone No:		City:
Nearest Relative: (not living with you, and not parents)
Address:		Phone:

GENERAL LOAN INFORMATION
Reason for Loan and amount:
Amount:		Reason:
How did you hear about us?

VEHICLE BEING PURCHASED OR USED FOR SECURITY
Make:		Model:
Year:		Rego:
Vehicle Valuation:	$	Speedo/Km:
Deposit: ( if purchasing )	$	Repayment Term:
Petrol	Diesel	cc Rating:

INCOME		EXPENSES
Weekly take home pay:	$	Mortgage/Rent:	$
Partner take home pay:	$	HP & Credit Cards:	$
Other income:	$	Loans:	$

ASSETS		LIABILITIES
Home	$	Mortgage Balance:	$
Bank	$	Credit Accounts	$
Vehicles	$	Other Loans:	$
Investments	$	Business Loans:	$

CREDIT REFERENCE (Name of Finance Company/s)	1.
	2.
Personal Contact: (good friend)		Address:	House No, street, city
Phone:

Bank Name:		Branch:
Account No:

(please tick) I hereby agree and confirm that I have read the South Island Vehicle Finance* Privacy Policy and will comply with all the conditions set out within.

Signature: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Info@BorrowMoney.co.nz