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Finance Application Form

Are you applying for finance with a Co-Buyer / Spouse? /
Loan Details
$
Loan Amount		 * (min. $5000)
     
Applicant Details
Title: *    
First Name * Middle Name
Last Name * Date of Birth * dd/mm/yyyy
Licence No * Licence State *
Email Address * Marital Status *
Home Phone * Telephone (BH) *
Mobile No. of Dependants
Current Address
Living Arrangement * Unit Number
Street Number * Street Name *
Street Type * City/Suburb *
State * Post Code *
Time At Address years mths*    
Previous Address (if less than 3 years at current address)
Unit Number Street Number
Street Name Street Type
City/Suburb State
Post Code Time At Address years mths
Primary Employment Details (Please record your last 3 years of employment)
Employment Status * Job Title *
Employer Name * Employer ABN
Employer Address * Employer Suburb *
State * Employment Contact Person *
Employer Telephone * Employed For years mths *
Previous Employment (if less than 3 years at current job)
Job Title Employer Name
Employer Address Employer Telephone
Employed For years mths  
Previous Employment (if less than 3 years at current job)
Job Title Employer Name
Employer Address Employer Telephone
Employed For years mths  
Co-Buyer/Spouse Details (if applicable):
Title: *    
Given Name * Middle Name
Family Name * Date of Birth * dd/mm/yyyy
License No * License State *
Email Address * Marital Status *
Home Phone * Telephone (BH) *
Mobile No. of Dependants
Co-Buyer/Spouse Current Address
Living Arrangement * Unit Number
Street Number * Street Name *
Street Type * City/Suburb *
State * Post Code *
Time At Address years mths *    
Co-Buyer/Spouse Previous Address (if less than 3 years):
Unit Number Street Number
Street Name Street Type
City/Suburb State
Post Code Time At Address years mths
Co-Buyer/Spouse Primary Employment Details (Please record your last 3 years of employment)
Employment Status * Job Title *
Employer Name * Employer ABN
Employer Address * Employer Suburb *
State * Employment Contact Person *
Employer Telephone * Employed For years mths *
Co-Buyer/Spouse Previous Employment (if less than 3 years at current job)
Job Title Employer Name
Employer Address Employer Telephone
Employed For years mths  
Co-Buyer/Spouse Previous Employment (if less than 3 years at current job)
Job Title Employer Name
Employer Address Employer Telephone
Employed For mths  
Income
Borrower Details  
$
Regular Gross Monthly Income		 *
$
Extra Income (e.g. Family Allowance)
Expenditure
Borrower Details  
$
Rent/Mortgage Payments Per Month
$
Credit Card Min. Monthly Payment
$
Other Loan Repayments Per Month
Type of Loan
Finance Reference (Companies you have borrowed money from in the past or at present)
Lenders Name Loan Type
Loan Term years mths Monthly Payment
Outstanding Balance (if any)    
1st - Personal Reference (not living with you)
Personal Reference Name * Personal Reference Relationship *
Telephone Number (land line) * Unit Number
Street Number * Street Name *
Street Type * City/Suburb *
State * Post Code *
2nd - Personal Reference (not living with you)
Personal Reference Name * Personal Reference Relationship *
Telephone Number (land line or mobile) * Unit Number
Street Number * Street Name *
Street Type * City/Suburb *
State * Post Code *
Bank Account Details
Bank Name * Bank Account Name *
BSB Number * Account Number *
Type of Account * Payment Method *
Additional Information:
Please add any information that may assist us with assessing your loan application.
Privacy Policy

PRIVACY ACT 1988 CONSENT

AUTHORISATION TO ACT ON BEHALF OF INDIVIDUALS

SURFSIDE AUTO GROUP PTY LTD - ACN 102 211 914 - TRADING AS BINKS AUTOMOTIVE

IN CONJUNCTION WITH EZYLOAN CAR FINANCE PTY LTD ( “THE INTRODUCER” )

21 FERRY ROAD, SOUTHPORT QLD 4215 DEALER LICENCE NO. 2602373

Agreement by the Applicant/s

I/We understand and agree that:

  1. A credit provider whom the Introducer may approach in arranging finance on my/our behalf (the “Approached Credit Provider”) may give a credit reporting agency certain personal information about me/us including :
    • Such permitted particulars about me/us which allow me/us to be identified ;
    • That I/We have applied for finance and the amount ;
    • That the Approached Credit Provider is a current provider to me/us or has ceased to be a current credit provider to me/us ;
    • Payments which are overdue more than 60 days, and for which collection action has been commenced ;
    • Advice that payments are no longer overdue ;
    • Cheques drawn by me/us for $100 or more which have been dishonoured more than once ;
    • In specified circumstances, that in the opinion of the Approached Credit Provider, I/We have committed a serious credit infringement.
  2. The Approached Credit Provider may obtain a report about my/our commercial activities or commercial credit worthiness from a business which provides information about the commercial credit worthiness of persons for the purpose of assessing my/our application for personal credit.
  3. 1.The Approached Credit Provider may obtain from a credit reporting agency a credit report containing personal information about me/us for the purpose of assessing my/our application for commercial credit.
  4. 1.The Approached Credit Provider may give to and obtain from another credit provider information about my/our personal or commercial credit arrangements for the purposes of assessing my/our finance application or credit worthiness, of collecting overdue payments or of notifying other credit providers of a default by me/us. I/We understand that this information can include any information about my/our credit worthiness, credit standing, credit history or credit capacity that credit providers are allowed to exchange under the Privacy Act.
  5. 1.The Approached Credit Provider may disclose to a guarantor, credit information relating to me/us and may also provide such information to a person who is considering whether to become a guarantor, for that purpose.
  6. 1.If my/our application for credit is not completed within 14 days, the Approached Credit Provider may give a credit reporting agency further personal information about me/us in order to obtain a credit report about me/us.

    7. Authorisation to Act on Behalf of Individuals

  7. I/We authorise the Introducer to :
    • Obtain on my/our behalf a report or information about my/our consumer or commercial credit worthiness from a credit reporting agency, from a commercial credit reporting business or from a credit provider in connection with my/our application for the finance described below.
    • a.Pass on such reports and information to the Approached Credit Provider for the purpose of assessing my/our application for finance described below, and to give to and receive from such persons as are relevant to the arranging of that finance, any personal information about me/us as may be necessary to the arrangement.
  8. I/We agree that if finance is provided to me/us by the Approached Credit Provider, I/We authorise the Introducer to obtain from the Approached Credit Provider any report or information concerning either me/us or that finance that it may require in order to :
    • Assist me/us in understanding and meeting my/our obligations to the credit provider in relation to that finance ;
    • Advise me/us regarding my/our finance requirements ;
    • Ascertain any amount required to be paid to the Approached Credit Provider in relation to that finance.

I/We understand that this paragraph may also be deleted if I/We do not agree. I/We also understand that this authority will continue for the duration of the finance unless and until I/We revoke it by notice to the Introducer and the Approached Credit Provider.

I / We have read the Privacy Policy
I / We are over 18 years of age
 
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