Money Simplicity - Equipment Finance Apply Online

Company details.

Company Name
ABN/ACN
Company Address	Unit No / Street No
Street Name
Suburb
State	Postcode
Company Phone Number
Company Start Date	as dd/mm/yyyy
Number of Staff
Bank name and branch	Bank name Branch
Trade Reference 1	Company Name Landline Ph No
	Contact Person
Trade Reference 2	Company Name Landline Ph No
	Contact Person
Company Accountants Business Name
Contact Person at Accountant
Accountants Phone Number
Accountants Email Address
Do you have your most recent tax returns?	Yes No
A couple of important credit questions.
Do you have credit defaults?	(If YES provide details.)
Are all current credit commitments up to date?	(If NO provide details.)

Director 1 First Name
Director 1 Middle Name
Director 1 Last Name
Gender
Date of Birth	as dd/mm/yyyy
Drivers Licence Number	Expiry Date: State
Marital Status
Number of Dependants
Are you an Australian Citizen
Address	Unit No / Street No
Street Name
Suburb
State	Postcode
Residence Status	If you rent, monthly payment is $
If you rent please supply Agent / Landlord Name	Phone Number
Date Moved In	as dd/mm/yyyy
Telephone Home
Telephone Mobile
Email Address
Gross Annual Income	$ per year
Family Allowance etc.	$ per year
Invest Property Rental Income	$ per year
Do you have any other income?	Yes No

Director 2 First Name
Director 2 Middle Name
Director 2 Last Name
Gender
Relationship to Director 1
Date of Birth	as dd/mm/yyyy
Drivers Licence Number	Expiry Date: State
Marital Status	As Above or
Dependants?	As Above or
Are you an Australian Citizen
Address	As Above or Unit No / Street No
Street Name
Suburb
State	Postcode
Date Moved In	as dd/mm/yyyy
Telephone Home	As Above or
Applicant 2 Mobile Number
Applicant 2 Email Address
Applicant 2 Occupation	Status
Directorship Start Date	as dd/mm/yyyy
Gross Annual Income	$ per year
Family Allowance etc.	$ per year
Investment Property Rental Income	$ per year
Do you have any other income?	Yes No

Are there are any lenders that you do not wish to deal with?
Do you have any preference as to the type of lender that you deal with?

Amount you wish to borrow.	$
Preferred Monthly Payment	$ per month	Loan Term yrs
	in Arrears Advance	Residual/Balloon Payment $
Details of the equipment.
What type of car or truck are you purchasing?	New Used
Equipment Details	Year	Price $
	Make	Model
	Description
Who are you purchasing the equipment from?	Dealer Private Sale
Their details.	Name	Address
	Phone	Pick up date
Complete this section if you are looking to replace a current facility or payout a residual or balloon payment that is coming due.
Current Lender
Account Number		Monthly Payment $
Previous Equipment Details	Year	Original Price
	Make	Model
	Description
Any other relevant information

	Their name:
Is there anything else you would like to add or do you have any questions?
I/We hereby request a proposal for a loan to be prepared by Money Simplicity and understand that such a proposal will be based on information provided herein, which is true and correct. We agree