Apply Online

EQUIPMENT FINANCE APPLICATION FORM Please complete & submit online or print & fax to 03 8637 1656

Vendor/Broker Details
Vendor/Broker Name			Mobile

Contact Name		Phone	Fax

Email


Customer Details
Customer Name Put company/individual name/s in full			A.C.N.

Trading As (if applicable)			A.B.N

Customer Address (in full)			Post Code

Contact Name		Phone	Fax

		Mobile	Email

Nature of Business		Years Owned	Years Established


Individuals/Directors/Guarantors
1		2	3
Full Name		Full Name	Full Name

Date of Birth		Date of Birth	Date of Birth

Full Address		Full Address	Full Address

Driver's Licence		Driver's Licence	Driver's Licence

Do you own your home?		Do you own your home?	Do you own your home?
Yes No		Yes No	Yes No
Real Estate Value $		Real Estate Value $	Real Estate Value $

Mortgage $		Mortgage $	Mortgage $


Equipment & Finance Details
More than one item? Download the Excel version
New or Used?		Year of Manufacture?
New Used
Equipment General Description

Make		Model	Serial/VIN/Rego

Price incl. GST	Dep/Trade-in	Finance Type	Term (mths)	Residual (%)

Site Usage of Goods

Supplier of Goods			Supplier Phone


		A Privacy Act Acknowledgement and Consent Form will sent separately for execution following the receipt of your completed application.
*Fees, terms and lending limits apply, based on the collateral being financed.

Level 9, 222 Kings Way, South Melbourne, Vic, 3205

Tel: 03 8637 1655 Fax: 03 8637 1656