APPLICATION – WTA Finance

Business Credit Application

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Section 1 - Type of Business:

Other

If other please provide details

Nature of business:

Company name:

Trust name:

Trading name:

ABN:

ACN:

Phone:

Fax:

Email:

Date Business Commenced Trading:

Section 2 - Details of Partners / Directors (If more than 2 Partners Directors please use additional sheets) Director 1 First name:

Partner / Director 1 - Personal Details - First Name

Details of Partners / Directors (If more than 2 Partners Directors please use additional sheets) Director 2 First name:

Partner / Director 2 - Personal Details - First Name

Director 1 Second Name:

Director 2 Second Name:

Director 1 Surname:

Director 2 Surname:

Director 1 Gender:

Director 2 Gender:

Director 1 Date of birth:

Director 2 Date of birth:

Director 1 Number of dependants:

Director 2 Number of dependants:

Director 1 Drivers Licence number:

Director 2 Drivers Licence number:

Partner / Director 1 - Address Details

Street address /Suburb/ Postcode/State

Partner / Director 2 - Address Details

Street address /Suburb/ Postcode/State

Director 1 Phone number (Home):

Director 2 Phone number (Home):

Director 1 Phone Number (Work):

Director 2 Phone number (Work)"

Director 1 Mobile number:

Director 2 Mobile number:

Director 1 Fax number:

Director 2 Fax Number:

Director 1 Email Address

Director 2 Email Address

Director 1 Residential Status:

Director 2 Residential Status:

Director 1 Duration at residence: Years

Director 1 Duration at residence: Months

Director 2 Duration at residence: Years

Director 2 Duration at residence: Months

Director 1 Previous Address (If less than 3 years at current)

Street address /Suburb/ Postcode/State

Director 2 Previous Address (If less than 3 years at current)

Street address /Suburb/ Postcode/State

Director 1 Duration at residence: Years

Director 1 Duration at residence: Months

Director 2 Duration at residence: Years

Director 2 Duration at residence: Months

Partner / Director 1 Personal Assets - Cash at Bank

Partner / Director 2 Personal Assets - Cash at Bank

Partner / Director 1 Home value:

Partner / Director 2 Home value:

Partner / Director 1 Other Property Value:

Partner / Director 2 Other Property Value:

Partner / Director 1 Motor Vehicles:

Partner / Director 2 Motor Vehicles:

Partner / Director 1 Household Effects:

Partner / Director 2 Household Effects:

Partner / Director 1 Business Assets:

Partner / Director 2 Business Assets:

Partner / Director 1 Term Deposit:

Partner / Director 2 Term Deposit:

Partner / Director 1 Other Assets:

Partner / Director 2 Other Assets:

Partner / Director 1 Details of Other Assets:

Partner / Director 2 Details of Other Assets:

Partner / Director 1 Details of Other Assets:

Partner / Director 2 Details of Other Assets:

Partner / Director 1 Details of Other Assets:

Partner / Director 2 Details of Other Assets:

Partner / Director 1 Personal Liabilities Home mortgage

Partner / Director 2 Personal Liabilities Home mortgage

Partner / Director 1 Other Property Mortgages:

Partner / Director 2 Other Property Mortgages:

Partner / Director 1 Credit Card (Limit):

Partner / Director 2 Credit Card (Limit):

Partner / Director 1 Loans Outstanding:

Partner / Director 2 Loans Outstanding:

Partner / Director 1 Other Liabilities:

Partner / Director 2 Other Liabilities:

Partner / Director 1 Other Liabilities:

Partner / Director 2 Other Liabilities:

Partner / Director 1 Other Liabilities:

Partner / Director 2 Other Liabilities:

Partner / Director 1 Other Liabilities:

Partner / Director 2 Other Liabilities:

Partner / Director 1 Other Liabilities:

Partner / Director 2 Other Liabilities:

Partner / Director 1: Details of Loans Outstanding

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Partner / Director 2: Details of Loans Outstanding

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Company / Business Assets

Cash in Bank:

Property Value:

Other Property Value:

Motor Vehicles:

Office Equipment:

Tools of Trade:

Trade Debtors:

Other Assets

Company / Business Liabilities

Property Mortgage:

Other Property Mortgages:

Overdraft (Limit ):

Trade Creditors:

Credit Card (Limit ):

Outstanding Taxes:

Loans Outstanding:

Other Liabilities:

Company / Business: Details of Loans Outstanding

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

Finance Company and Goods Purchased

Payments

Start Date

Term

To be paid out?

References

Bank Name

Address

Type of account

Accountant Name

Address

Telephone

Trade References

Name

Address

Telephone

Contact name

Name

Address

Telephone

Contact name

Name

Address

Telephone

Contact name

Loan Details

Cost of goods

Preferred term in months

Amount of Deposit

Amount of trade

Residual if required

`Preferred facility

Total amount financed

Details of Vehicle Being Purchased (If applicable)

Make:

Model:

Year:

Engine Capicity:

Type (Sedan, Ute, Etc):

Odometer Reading:

Extra Accessories:

*** We would like to be contacted regarding an insurance quote on this vehicle ***

(Please tick)

Goods Being Purchased (Non Motor Vehicle)

Supplier Details

Private Sale

Name of supplier / dealer

Contact Name:

Telephone:

Brief Outline of Background of business plus partners / directors and current operations

I/We declare that the above information is true & correct, that I/We are not undisclosed bankrupts and that there are no unsatisfied judgements made against me/us. *