I am looking
for
Build a new home
Buy my first home
Buy an investment
property
Buy a new home
Car Boat
Truck Van Loan / Lease
Commercial Loan
Equipment Lease
Refinance an
existing loan
Reversed Mortgage
Small Business Loan
None
When
None
Immediate
Next 3 months
3-6 months
6-12 months
Greater than 12
months
Loan Amount
$
Credit
History
None
Good
One paid default
Poor
Don’t know
Annual
Combined Income ($)
None
$0 - $30,000
$30,001 - $40,000
$40,001 - $50,000
$50,001 - $60,000
$60,001 - $70,000
$70,001 - $80,000
$80,001 - $90,000
$90,001 - $100,000
$100,000+
Main Applicant Work Status
None
Part time employee (less than 25hrs/week)
Full time employee (more than 25hrs/week)
Self-employed
I am currently
out of work
Marital
Status
Single
Married/Defacto
relationship
Separated/Divorced
None
Dependents
( incl. children under 18)
0
1
2
3
4+
Title
Mr
Mrs
Ms
Miss
Dr
First Name
Surname
Name
Address
Suburb
Post Code State
NSW
VIC
QLD
ACT
WA
SA
NT
TAS
None
Mobile
Number
Home Tel Number
Email
NOTES
When is the best
time to call
None
between 9am & 12
noon
between 12 pm & 1pm
between 1 pm & 3 pm
between 3 pm & 5 pm
between 7 pm & 9 pm
any time
during working hours
any time between
9am - 8pm
Verifier
What is 99 plus ONE