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Adelaide independent finance pty limited - Australia.
189, Main North Road, Nailsworth, South Australia
ACN: 135 816 803

CREDIT APPLICATION FORM

Loan Purpose:
Enter why you require the loan
(i.e to purchase a car for transport to & from work)
Amount:
 Enter the amount you wish to loan
(i.e $5,000)

CREDIT TERMS UP TO 36 MONTHS

Title:
 Select your prefered title
Marital Status:
Children:
Surname:
Given names:
License No.
 Drivers license no.
(this is found at the Top Right hand side of your license)

Date of Birth:
Home Phone:
Work Phone:
Mobile Phone:
Current Address:
Current Address
The address where you are living at the moment.
Postcode:
How long have you lived at the above address?
Are you Renting, Buying or Boarding?
Select Renting, Buying or Boarding
Note: If you select Renting OR Buying please enter the Landlord or Mortgagee name and phone number in relevent box below.
Landlord or Mortgagee:
 Phone:

Previous Address

Previous Address:
Previous Address
The last address you used to live at.
Postcode:
How long did you live at the above address?

Employment

Occupation:
Current Employer :
 Phone:
How long:
 Wages:
Previous Employer :
 Phone:
How long:
 Wages:
Other income:
Any other income
Enter any other income you have besides your current job

Credit History

Current Loans :
Previous Loans :

Weekly Expenditure

Rent / Mortgage :
$
Food:
$
Phone:
$
Loans:
 $
Other Expenditure:
$
Total:
 $ TOTAL
This figure is calculated Automatically as you fill in the weekly expenditure amounts above.

Nearest Relative

Name & Address of nearest relative NOT living with you:
Phone:
 Mobile:

Name, Address & Phone No's of Three (3) friends

Friend 1 Address:
Phone:
 Mobile:
Friend 2 Address:
Phone:
 Mobile:
Friend 3 Address:
Phone:
 Mobile:

Privacy Agreement

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