Application Form

APPLICANT DETAILS

Business Name:

ABN:

Contact Name:

Position:

Phone Number:

Fax Number:

Email Address:

Type of Entity (Tick one):

 Top 500 Company Partnership Sole Trader Government Other Company Individual Trust


Type of Business

Trading Address

Street:

Suburb/Town:

State:       Post Code:


Home Address

Street:

Suburb/Town:

State:       Post Code:


I am a property owner:  YES NO

Property Value: $       Mortgage owing: $

Property Street Address:

Suburb/Town:

State:       Post Code:

TRANSACTION DETAILS

Type of Equipment:

 Office Furniture IT AV Equipment Telecommunications Motor Vehicle Industrial

Other (Please specify):

Equipment Value (ex GST): $

Equipment Supplier:

Monthly Payment: $

Preferred Term:  24 months 36 months 48 months 60 months

FOR MOTOR VEHICLES

Make:       Registration No:

State of registration:       Year Made:

Vin No:       Chassis No:

Privacy Declaration and Authorisation to Release Information

I/we (being the Lessee/s) hereby certify that the information that has been provided is wholly true and not misleading. Pursuant to the Privacy Act 1988 (Cth), I/we authorise and consent LEASECHOICE Pty Ltd ABN 11 101 633 738 ('LEASECHOICE') collecting from and providing to credit reporting agencies personal information (being consumer credit information and any other relevant information about me/us), and to seek and obtain consumer credit references/reports to allow LEASECHOICE to assess my/our application, manage my/our account, recover any money that I/we owe, and/or finance another product (currently or in the future) to me/us. I/we also acknowledge that the credit/commercial credit applied for may be provided by another credit provider. I/we acknowledge and authorise that in such cases, LEASECHOICE may disclose my/our personal information to such credit provider for the purposes of assessing my/our application, including information about my/our consumer or commercial credit worthinessor financial capacity. I/we acknowledge and authorise you to disclose my/our personal information to others who perform a function or service for, or related to the purposes you collect, use or disclose the information, including agents. These may include introducers, debt collection agents, valuers, solicitors or accountants, and funders. You may also seek information from government authorities or others to enable you to identify me/us and verify information I/we have provided. This may be to locate me or us or the assets. It may include searches of electoral rolls, land titles, business names or ASIC, bankruptcies and court judgments and telephone numbers. I/we acknowledge that if we fail to provide sufficient personal information, my/our application may not be able to proceed. I/we acknowledge that I/we may access my/our personal information by contacting LEASECHOICE on 1800 220 225. I/we further authorise our accountant or financial officer to provide LEASECHOICE such information, if any, which LEASECHOICE may require in relation to our financial position including copies of our financial statements for the purposes of assessing this application. I/we also authorise you to collect personal information about me/us from my/our introducer, legal advisers, and referees.

Name:

Position:

Driver's License:

Date of Birth:

Your Email (required)

Name
Contact Number
Enquiry Type