|
 |
| Your Name |
Web Address |
|
|
| Company Name |
Would you like to organise a link from |
|
|
your website? |
| ABN |
No. of Offices |
No. of Staff |
|
Email Address |
|
|
| Phone Number |
Fax Number |
|
|
| Trading Address |
Industry |
| |
|
| |
| Company Structure Information |
|
|
| Director(s) Names, Date of Birth & Qualifications: |
History of the Business: |
|
|
| Shareholder(s) Names, Percentage Held: |
List Products/Services Provided: |
|
|
|
| |
| Company Reference Information |
|
|
| List any accreditations held with Banks/Financiers: |
List any associations that you are a member of and any licenses you hold: |
|
|
| Do you hold any of the following Insurance? |
Any material litigation Pending: |
|
|
|
| |
| Current Lease Finance Information |
|
|
|
| Type of Clients financed: |
|
Top 500 Corporate
Government
Business
Individuals |
| Other (Please Specify) |
|
| |
| 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 ACN 092 582 655 ('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 worthiness or 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. |
| |
|
|
|
|
