Westralian Finance Application Form

Type of Loan Please Select... Car Loan Secured Loan Boat Loan Equipment Loan Truck Loan Loan Amount * (Minimum $5000)

Title Please Select... Mr. Mrs. Miss. Ms. Other *

Please Specify *

First Name * Middle Name None * Last Name *

Date of Birth Day 010203 040506 070809 101112 131415 161718 192021 222324 252627 282930 31 Month JanuaryFebruaryMarch AprilMayJune JulyAugustSeptember OctoberNovemberDecember * Licence No * Licence State Please Select... Aust. Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia New Zealand Overseas * Email Address * Marital Status Please Select... Single Married Divorced Separated Defacto * No. of Dependants

Please provide at least one contact number and nominate which is preferred: *

Home Phone Preferred Business Phone Preferred Mobile Preferred

Living Arrangement Please Select... Boarding Mortgaged Renting Owned outright * Unit Number Street Number * Street Name * Street Type * City/Suburb * State Please Select... Aust. Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia New Zealand Overseas * Post Code *

Time At Address yrs mths * Landlord Name (If renting) Landlord Ph (If renting)

Unit Number Street Number Street Name Street Type City/Suburb State Please Select... Aust. Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia New Zealand Overseas Post Code

Time At Address yrs mths

Employment Status Please Select... Full Time Part Time Casual * Job Title * Employer Name * Employer ABN Employer Address Employer Suburb State Please Select... Aust. Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia New Zealand Overseas Employment Contact Person * Employer Telephone *

Employed For yrs mths *

Previous Employment Details (If less than 3 years at current job)

Job Title Employer Name Employer Address Employer Telephone

Employed For yrs mths

Title Please Select... Mr. Mrs. Miss. Ms. Other

Please Specify

Given Name Middle Name Family Name

Date of Birth 010203 040506 070809 101112 131415 161718 192021 222324 252627 282930 31 JanuaryFebruaryMarch AprilMayJune JulyAugustSeptember OctoberNovemberDecember License No License State Email Address Marital Status Single Married Divorced Separated Defacto No. of Dependants

Please provide at least one contact number and nominate which is preferred: *

Home Phone Preferred Business Phone Preferred Mobile Preferred

Living Arrangement Please Select... Boarding Mortgaged Renting Owned outright Unit Number Street Number Street Name Street Type City/Suburb State Please Select... Aust. Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia New Zealand Overseas Post Code

Time At Address yrs mths Landlord Name (If renting) Landlord Ph (If renting)

Unit Number Street Number Street Name Street Type City/Suburb State Please Select... Aust. Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia New Zealand Overseas Post Code

Time At Address yrs mths

Employment Status Full Time Part Time Casual Job Title Employer Name Employer ABN Employer Address Employer Suburb State Please Select... Aust. Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia New Zealand Overseas Employment Contact Person Employer Telephone

Employed For yrs mths

Job Title Employer Name Employer Address Employer Telephone

Employed For yrs mths

Net Income (After Tax) Weekly Fornightly Monthly *

Extra Income (After Tax) Source

Rent/Mortgage Payments Per Month Credit Card Limit Other Loan Repayments Per Month Type of Loan

Lenders Name Loan Type

Loan Term yrs mths Monthly Payment Outstanding Balance (if any)

Personal Reference Name Telephone Number Suburb

Personal Reference Name Telephone Number Suburb

Bank Name Branch

Please add any information that may assist us with assessing your loan application. Anti-Spam Check