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Simply fill in your details below. You may choose to fill in the first section of required fields (*) and we will contact you to discuss your application and further information we will require.

Alternatively, complete both the first section and the 'Additional Information' section to speed up your loan application.

Once all your information is collated, we can have an answer for you within 2–4 hours.

Please be accurate when providing information and expect our call shortly.

PERSONAL DETAILS (FIRST APPLICANT)

Title

First Name *

Last Name *

Email *

Current Address

Phone Number

City

Mobile Number

OPTIONAL LOAN DETAILS

Previous address (if less than 2 years)

Amount Required

Date of Birth

What security do you have?

Marital Status

Occupation

Employee status

Employer

Length of time with current employer (x years, y months)

Employer phone number

If less than 3 years please give previous employer and length of time

Number of dependants

Where did you hear about us?

Reason for loan

Credit status

PERSONAL INFORMATION (FIRST APPLICANT)

Driving Licence No

Licence expiry date (dd/mm/yy)

Driving Licence Version

Car Registration No

INCOME APPLICANT ONE

Net Income $

Freequency

Other Income $

Freequency

Total Income $

Freequency

Expenses (all in $ value)

Mortgage/Rent/Board $

Vehicle Loan 1 $

Vehicle Loan 2 $

Other Loan/HP $

Maintenance Payments $

Insurance Life/House/Car $

Utilities Rates/Power/Phone/Mobile $

Food and Living Expenses $

STATEMENT OF FINANCIAL POSITION

Total Expenses $

Income less Expenses $

Assets

Home & Section/Land only $

Vehicle 1 $

Vehicle 2 $

Furniture $

Bank/Building Society $

Business Equity $

Other $

Total Assets

Liabilities

Mortgage $

Mortgage Company

Vehicle Loan 1 $

Vehicle Loan 1 Company

Vehicle Loan 2 $

Vehicle Loan 2 Company

HP $

HP Company

Credit Cards $

Credit Cards Company

Bank Overdraft $

Bank Overdraft Company

Other $

Other Company

Total Liabilities $

Income Applicant Two

Title

Last name

Date of Birth

Current address

City

Previous address

Phone number

Mobile number

Marital status

Occupation

Employment status

Employer

Employer phone number

Number of dependants

New Zealand residency?

Driving Licence No.

Driving Licence version

Net Income (2nd applicant) $

Net Income (2nd applicant) frequency

Other Income (2nd applicant) $

Total Income (2nd applicant) $

Total Income (2nd applicant) frequency

REFERENCES

Applicant One Next of Kin

Phone / Mobile

Applicant Two Next of Kin

Phone / Mobile

Applicant One Personal Reference

Phone / Mobile

Applicant Two Personal Reference

Phone / Mobile

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