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1. Loan Amount Amount You Wish To Consolidate * Please Select Amount $8000 - $10000 $10000 - $15000 $15000 - $20000 $20000 - $25000 $25000 - $30000 $30000 - $35000 $35000 - $40000 $40000 plus 2. Credit Cards & Store Cards How Many Credit Cards / Store Cards Do You Have : Please Select - - - 1 2 3 4 5 None * Card Type * Outstanding Balance * Credit Provider * Credit Card Store Card $ Credit Card Store Card $ Credit Card Store Card $ Credit Card Store Card $ Credit Card Store Card $ If you have more credit cards / store cards list them in Additional Notes 3. Personal Loans & Car Loans How Many Personal Loans / Car Loans Do You Have : Please Select - - - 1 2 3 4 5 None * Loan Type * Outstanding Balance $ * Credit Provider * Personal Loan Car Loan $ Personal Loan Car Loan $ Personal Loan Car Loan $ Personal Loan Car Loan $ Personal Loan Car Loan $ If you have more personal loans / car loans, list them in Additional Notes 4. Real Estate Assets How Many Real Estate Assets Do You Have : Please Select - - - 1 2 3 4 5 None * Value Of Real Estate Asset $* Outstanding Mortgage $* 1 $ $ 2 $ $ 3 $ $ 4 $ $ 5 $ $ If you have more real estate assets, list them in Additional Notes 5. Employment Details Do You Work Fulltime * Please Select --- Yes No Are You Self-Employed * Please Select --- Yes No Do You Have Full Financials For Last 2 Years ? * Please Select --- Yes No How Long Have You Been With You Current Employer or Self Employed ? * 6. About Your Credit History Do You Have Late Payments / Defaults / Arrears * Please Select --- Yes No Unsure If "Yes" please describe in details 7. Contact Details First Name * Last Name * Street Address* Suburb* State* Select -- Vic NSW QLD NT SA ACT WA TAS Post Code* Home Phone * () * Please provide at least 2 contact numbers Work Phone * () Mobile * Email * Preferred Contact Time * Time Any Time 8am-12pm 12pm-5pm After 5pm Day Any Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday Additional Notes: Please enter the * verification number
Amount You Wish To Consolidate *
How Many Credit Cards / Store Cards Do You Have :
Card Type *
Outstanding Balance *
Credit Provider *
$
If you have more credit cards / store cards list them in Additional Notes
How Many Personal Loans / Car Loans Do You Have :
Loan Type *
Outstanding Balance $ *
If you have more personal loans / car loans, list them in Additional Notes
How Many Real Estate Assets Do You Have :
Value Of Real Estate Asset $*
Outstanding Mortgage $*
If you have more real estate assets, list them in Additional Notes
Do You Work Fulltime *
Are You Self-Employed *
Do You Have Full Financials For Last 2 Years ? *
How Long Have You Been With You Current Employer or Self Employed ? *
Do You Have Late Payments / Defaults / Arrears *
If "Yes" please describe in details
First Name *
Last Name *
Street Address*
Suburb*
State*
Post Code*
Home Phone *
* Please provide at least 2 contact numbers
Work Phone *
Mobile *
Email *
Preferred Contact Time *
Additional Notes:
Please enter the * verification number
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