Vehicle Details

I am looking for a vehicle up to:

Finance Details

I have a deposit of…

I would like a term of…

months

Employment Details

Current Employer

Current Employer Address

Current Occupation

Current length of employment

years

Previous Employer

Previous Occupation

Spouse Employer

Spouse Employer Address

Spouse Occupation

Spouse length of employment

years

Applicant Details

Surname

Christian Names

Date of Birth
DD / MM / YYYY

Marital Status

Select...

Single Married Divorced De Facto

Number of Dependants

Drivers Licence Number

Drivers Licence Type

Select...

Learners Restricted Full

Spouse Surname

Spouse Christian Names

Spouse Date of Birth

Spouse Drivers Licence Number

Address Details

Address & Tenancy

Select...

Own House Renting Boarding Family House Other

Details (If Selected Other)

Current Address

Years at Current Address

Previous Address

Years at Previous Address

Contact Details

Main Contact Number
e.g. 09-555-5555

Mobile Phone
e.g. 021-555-5555

Business Phone

Facsimile

Email Address

Alternative Contact Details

Parents Name or Nearest Relative

Relationship

Address

Phone Number

Another Contact

Relationship

Address

Phone Number

Financial Details

Account Reference 1
(HP/Credit Card, etc.)

Account Reference 2
(HP/Credit Card, etc.)

I/We apply for the above loan and certify that the particulars above and overleaf are true and correct, that I/we are over the age of 18 years and am not an undischarged bankrupt. Pursuant to the Privacy Act 1993 I/we authorise Ted Traceys LMVD or any Finance Company including but not limited to Falcon Advances, Global Credit, GE Finance & Insurance, Marac, UDC Finance Ltd/ANZ Banking Group (NZ) Ltd, or Senate, to contact any credit reporting agencies, credit providers, my/our employers, accountants, or any other source, to obtain, check and exchange such personal, financial and commercial information and references as is necessary for the purpose of considering this application, the protection and administration of any loan arising out of this application and to assist the enforcement of any agreement between me/us and any finance company. I/We agree that you may reproduce this authority to such parties for the purpose of collecting such information. Under the provisions of the Privacy Act 1993, you are entitled to have access and request correction to personal information held about you.

By clicking "Submit Application", I/we warrant that the information provided in this application is true and correct and I/We agree to the terms of the PRIVACY ACT 1993