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Customer Details
Type of Business*
- Company
- Partnership
- Individual
- Other
Legal Name*
Trading Name*
ABN / ACN*
Business Address
Address*
Suburb*
State*
Postcode*
Is the mailing address the same as the business address?*
- Yes
- No
Mailing Address
Mailing Address*
Suburb*
State*
Postcode*
Contact Information
Contact Name*
Telephone*
Mobile*
Fax
Email*
Website
Business Details
Nature of Business*
Operating Since (month / year)*
Current Owners Since (month / year)*
How did you hear about us?
- Google
- Equipment Supplier
- I am an existing Finance Connections Customer
- Word of Mouth
- Other

Current Business Commitments
Financier 1
Expiry Date
Monthly Repayments
Financier 2
Expiry Date
Monthly Repayments
Other Financial Business Commitments
Referee Details
Accountant
Contact
Phone
Bank & Branch
Trade Reference (min 1 year)
Contact
Phone
Equipment Details
Equipment Description*
Approx Equipment Value*
Supplier Details
Supplier*
Contact*
Phone*

How many Directors / Partners / Guarantors does the Business have?
- 1
- 2
- 3 or more
Please fill out the first 2 principals details. We will contact you to get the details of the other principals of the business.
Person 1
Full Name
Drivers License No.
D.O.B.
Current Address
Suburb
State
Postcode
Are the premises...
- Owned
- Leased
Value of Premises $
Monthly Rent $
Person 2
Full Name
Drivers License No.
D.O.B.
Current Address
Suburb
State
Postcode
Are the premises...
- Owned
- Leased
Value of Premises $
Monthly Rent $
Personal Statement of Assets and Liabilities
Assets Person 1
Property Value
Motor Vehicle Value
Furniture & Fittings Value
Cash in Bank
Value of Investments & Other
Assets Person 2
Property Value
Motor Vehicle Value
Furniture & Fittings Value
Cash in Bank
Value of Investments & Other
Liabilities Person 1
Personal Loans Value
Personal Loans Value
Personal Loans Value
Liabilities Person 2
Mortgage Value
Personal Loans Value
Other

PRIVACY ACT CONSENT & DECLARATION
In compliance with the Commonwealth Privacy Act 1988, the Applicants and Guarantors (“I/We”) to the finance application should complete and return to the below named introducer/agent for the purposes of the Privacy Act.
Name of introducer/agent: Lark-Hill Group Unit Trust T/as Finance Connections (ABN 94 324 181 282)
Authority to obtain and disclose certain credit information concerning an Application for Finance.
To enable the agent/credit provider to assess my/our application for commercial or personal credit, I/we authorise the agent/credit provider to obtain: from a credit reporting agency, a credit report containing personal or commercial information about me/us in relation to personal or commercial credit provided to me/us: and from a business which provides information about the commercial creditworthiness of persons, information about my/o ur commercial activities or commercial credit worthiness (Section 18L (4)).
I/we acknowledge that Section 18E(8c) of the Privacy Act allows a credit provider which the approached introducer/agent may approach in arranging my/our finance, to give a credit reporting agency certain personal information about my/our application for finance:
The information which may be given to an agency is covered under Section 18E (1) of the Act and includes:
The fact that I/we have applied for finance and the amount;
Such permitted particulars about me /us which allow me/us to be identified;
The fact that the credit provider is a current credit provider to me/us;
Payments which become overdue more than 60 days, and for which collection action has commenced;
Advice that payments are no longer overdue;
Cheques drawn by me/us for an amount not less than $100, which have been dishonoured more than once;
That in the opinion of the above-named credit provider/agent, I/we have committed a serious credit infringement;
Information as to court judgements against me’ I/we acknowledge that a reference to the agent/introducer in this declaration is also a reference to a credit provider;
By virtue of this declaration, I/we understand the above-named introducer/agent has informed me/us of the disclosure policy to a credit reporting agency of information about me/us and so authorise such disclosures.
Other acknowledgments and Consents
I/We agree that the credit provider may give to and receive from the introducer/agent personal and/or commercial information about me in connection with this application, the processing, acceptance and on-going management of the facility.
I/We acknowledge that the credit provider relies on this information when making its decision. I/We acknowledge that the introducer/agent/credit provider has the right to confirm the details of the information provided in this application.
I/We understand that only the credit provider can decide whether this application is approved and that any introducer /agent to the credit provider has no authority to give that approval.
I/We acknowledge that the credit provider may pay a commission to the introducer/agent as a result of services rendered.
I/We consent to the credit provider exchanging information concerning my/our financial affairs with the introducer/agent.
I/We consent that my/our obligation for this debt will continue regardless of any changes in my/our circumstances.
I/We acknowledge that I/we may access my/our personal information by contacting 1800 50 60 10. If the credit applied for includes an insurance premium finance facility the applicant authorises the introducer/agent to provide information about it to a reinsurer or parties associated with the reinsurer for any purpose in connection with the contract of reinsurance between the credit provider/agent/introducer and the reinsurer.
I/We acknowledge as a guarantor(s) that the personal information obtained will be used to assess whether to accept me as a guarantor or to accept the support for such credit facilities. I consent to the introducer/agent/credit provider collecting, using and disclosing my personal information for this purpose.
I/We understand that if we fail to provide any information requested in this form, or do not agree to any of the possible exchanges or uses detailed above, my/our application may not be accepted.
I/We understand that the acknowledgments and consents specified above are restricted to this application only
I/We have read and I/we understand and agree to the declarations and consents relating to the protection of my/our privacy.
I/We confirm that the information contained in this application and the financial information supporting it, are in all respects complete and accurate.
Please only tick yes if you agree with the above Privacy Act, tick no to decline.*
- Yes
- No

Call 1800 50 60 10

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Finance Application - Private Company / Partnership / Sole Trader

Customer Details

Business Address

Mailing Address

Contact Information

Business Details

Current Business Commitments

Referee Details

Equipment Details

Supplier Details

Person 1

Person 2

Personal Statement of Assets and Liabilities

Assets Person 1

Assets Person 2

Liabilities Person 1

Liabilities Person 2