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Please fill out the Application Form form below and Submit. We shall contact you shortly.
You can also Download the Application form. Fax Back on 1800 220224
   APPLICANT DETAILS
Applicant Name Phone Number
Contact Name Email Address
Position Fax Number
ABN Driver License
Type of Entity Date of Birth
Top 500 Companies Partnership Government
Other Company Sole Trader Individual
(dd/mm/year)
 
Trading Address Home Address
Suburb Suburb
State   Post Code State   Post Code

I am a property owner:
YES       NO
Property Value:
  Mortgage owing:
Property Address
 
   TRANSACTION DETAILS
Date:

Introducer:

Equipment Vendor:


Typ of Equipment:
Office
Industrial
Mining
T
IT
POS
Medical
T
Telecommunications
Motor Vehicle

Other (please specify):  

Finance Amount:
$
Is this amount including or excluding GST?
including GST        excluding GST


Monthly Payment:

Preferred Term: 24 months 48 months
  36 months 60 months

Residual:

Finance Type:
Operating Lease/Rental        CHP      Finance Lease      Chattel Mortgage      Sale & Leaseback
    FOR MOTOR VEHICLES
Make / Model Year Made
Registration Number Vin No
State of Registration Chasis No.
    TRADE REFERENCES
REFERENCE 1 REFERENCE 2
Company Name Company Name
Contact Name Contact Name
Contact Phone Number Contact Phone Number
    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. 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 .

Acknowledgement and Consent of Guarantor(s):
By ticking the box below I/we acknowledge and consent to the following: I/we have read the Authorisation set out above and understand that it applies equally to me/us as guarantor(s). I/we acknowledge that LEASECHOICE may see a credit report concerning me/us from a credit reporting agency and all other information as set out above for the purpose of assessing whether to accept me/us as a guarantor for the finance commitments of the above named Lessee(s). I/we agree that this agreement remains in force until the attached agreement, which I/we hereby guarantee, ceases.

I have read the Privacy Act declaration and I authorise LeaseChoice to act in accordance with it.
 
This form does not constitute a contract.
LeaseChoice will contact you to discuss this facility and finalise the documentation.
Please enter the following characters in the field below: Au5D2y9
 

 

 
 
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