Credit Impaired Application

You can now apply online for a Credit Impaired Loan! Simply fill in the form below, making sure to answer all questions and not to miss any. We will process your application and contact you promptly.

Loan Request
Amount Requested
$
What is the purpose of the loan?
     
Personal Details
Applicant 1
Applicant 2
Surname
First Name
Middle Name
Date of Birth
Marital Status
Dependant Children?

Ages of Children
Drivers License #
Drivers License expiry
     
Telephone Numbers
Home
Work
Mobile
email Address
     
Residential Details
Full Home Address
Mailing Address
Length of time at this address
Are you:
Name of owner/ agent
Monthly accommodation cost:
$
$
Phone #
If at this address less than 3 years, provide previous address.
Length of time at that address
Were you
     
Current Employment
Employment Status
Occupation
Length of time with employer
Employers Name
Employers Address
Telephone #
     
Previous Employment
1.    
Occupation
Length of time with employer
Employers Name
Employers Address
Telephone #
     
2.    
Occupation
Length of time with employer
Employers Name
Employers Address
Telephone #
     
     
Assets - include home, contents, investments, vehicles, etc.
Description
Value
 
$
 
$
 
$
 
$
 
$
 
$
 
$
     
Liabilities - include personal loans, store cards, credit cards, etc.  
Lender:
$ Balance:
$ Limit:
$ Monthly Payment:
     
Budget
Figures below are:


     
Income
Applicant 1 net income:
$
Applicant 2 net income:
$
Other income(overtime etc):
$
Government Assistance:
$
     
Banking Details
Financial Institution
Branch
Balance
$
$
$
$
     
Credit History
Have you ever had, or are there now judgements or legal proceedings against you?
Do you have any defaults or judgements against you? If so, what are they?
     
Details of the nearest relative not living with you:
Name
Address
Phone Number
Relationship to this Relative
     
Please give 2 personal references:
Reference 1
Reference 2
Name
Address
Phone
   
How did you find us?
 
 
TERMS AND CONDITIONS - Please Read Carefully
 
     
By clicking the Submit Application button you confirm you have read and understand the terms and conditions above.