ONLINE APPLICATION FORM Receive a free gift with every successful application 123456 How much would you like to borrow?*Please enter a number greater than or equal to 800.Please enter a number greater than or equal to our minimum amount of $800. Please note, our Maximum borrowing amount for NZ beneficiaries is $3000.How much can you pay weekly?*Our customers usually pay $25-50 a week depending on the size of the loan. Choose an amount that feels right for you.Your First Name* Your Email Address* Your main contact number*Please include area code.Credit WarningIf you're applying with more than one finance company, this is NOT good for your credit score and will reduce the likelihood of your loan being approved. I understand and wish to proceed What will the money be used for?*Please selectCar repairsCar purchaseHealth expenses (i.e. medical or dental)Personal HolidayPersonal event (i.e. wedding or funeral)Home renovationDebt consolidationBusiness equipmentI'm supporting Borrower for another applicationOtherLet us know what you need this for. If you are a Supporting Borrower, there is an option for this here also.Please specify what the money will be used for?* What is the name of the person you are applying as a Supporting Borrower for?* Your DetailsYour Title* Mr Mrs Miss Ms Your First Name* Your Last Name* Marital Status*Please selectSingleDe Facto, Married, or Civil UnionSeparated or DivorcedWidowedDate of Birth* Day Month Year Your other contact number (optional) What is your current living situation?*Please selectOwn HomeRenting / FlattingLiving with ParentI am a New Zealand Resident / Citizen* Yes No Your Current Residential AddressNumber & Street* Suburb Postcode* If you are unsure you can find your postcode hereCity* How long have you been at this current address?*Please selectLess than 6 months6 months - 1 year1 - 2 years2 - 5 yearsMore than 5 yearsYour Previous Residential AddressNumber & Street* Suburb City* How long have you been at this previous address?*Please selectLess than 6 months6 months - 1 year1 - 2 years2 - 5 yearsMore than 5 years YOU’RE ALMOST DONE!Your IDYour ID type (choose only one option)* New Zealand Drivers Licence Passport (can be from any country) Other (Photo ID, 18+ card, firearms licence, etc.) Haven't got your ID right now?You can save your progress & continue later.Click the Save & Continue button at the bottom of this form.Driver's license number (5a)* Driver's license version (5b)* When does your drivers licence expire (4b)* Day Month Year Passport number* Passport country of issue* When does your passport expire (Month and Year)?* ID type* ID reference number When does your ID expire (Month and Year)? What Security Can you Provide?What Security Can you Provide?* I own a vehicle that can be used as security I own furniture & appliances that can be used as security I own a house that can be used as security I don’t have security, but I have a supporting borrower that can provide security Supporting borrower's name* Supporting borrower's phone* Make and model of your vehicle Year of vehicle's manufacture* Vehicle plate/reg* My vehicle is insured ?* Yes No You cannot use you car as security unless it is warranted, registered and insured.Company that insures the vehicle?* Do you owe money on the vehicle? No, I fully own it Yes, I'm paying it off Who do you owe the money for the vehicle to?* This is what we use as security for your loan so it needs to be worth at least as much as the amount you're borrowing. If you are not able to provide security, then a family member or a friend can act as a “supporting borrower” (if they can provide security on your behalf). Your occupationI'm a beneficiary I'm a beneficiary Yes, we lend to beneficiaries.Lending Notice* I acknowledge the below and want to proceed with my application.The maximum amount we can lend to beneficiaries is $4000.Your current job or occupation* Name of the place where you currently work* If you're a student, put your place of study. If you're unemployed, just put "none"How long have you been in your current job?*Please selectLess than 6 months6 months - 1 year1 - 2 years2 - 5 yearsMore than 5 years Have you been declared Bankrupt before or currently Under Summary Instalment Order or No Asset Procedure?*Please selectNoYesUnsureTerms and ConditionsI/We warrant that the information given above is true and correct and hereby AUTHORISE this lender making all enquiries and obtaining all information it shall deem necessary at its discretion. I/We AUTHORISE all companies, institutions, credit agencies, organizations and other persons approached by this company for information about me/us to provide the information requested. i/We acknowledge that this company shall not be required to comply with the provisions of Principle 3 of the Privacy Act 1993 as to whether I/We shall be aware of: the fact that the information is being collected, the purpose for which the information is being collected, the intended recipients of the information, the consequences for providing information, the rights of access to and correction of such information, or that the collection of the information is authorized or required by or under law If you agree to these Terms and Conditions you can submit your loan application now:Terms and Conditions* I agree to the Terms and Conditions above. English Proficiency* I have read and understood everything in this application. I understand English. Email Consent I agree to be contacted via email
