Finance Application

Applicant 1
Applicant Surname:*
First & Middle Names:*
Date of Birth (DD/MM/YYYY):*
Drivers Licence Number (5a):*
Version Number (5b):*
Licence Type:*
Other:
International & Country:
Residency Status (non NZ Citizens only):
Work VISA expiry date:
Version Number (5b):
Home Phone:
Work Phone:
Mobile:*
Email:*
Address:*
Postal Address (if different from physical):
Residential Status:
Other Specify:
Time at Current Address:*
Previous Address:
Time at Previous Address (If less than 3 years):
Current Employer:
Occupation:
Years in Current Role:
Current Employer Address:
Previous Employer (if current employer is less than 3 years):
Occupation:
Years in Previous Role:
Previous Employer Address:
Nearest Relative or Contact (not living with you):
Phone:
Relationship:
Address:
Previous Consumer Credit With 1:
Previous Consumer Credit With 2:
Applicant 2

No need to duplicate information if it is the same same as Applicant 1 (i.e. Address)

Applicant Surname:
First & Middle Names:
Date of Birth (DD/MM/YYYY):
Drivers Licence Number (5a):
Version Number (5b):
Licence Type:
Other:
International & Country:
Residency Status (non NZ Citizens only):
Work VISA expiry date:
Version Number (5b):
Home Phone:
Work Phone:
Mobile:
Email:
Address:
Postal Address (if different from physical):
Residential Status:
Other Specify:
Time at Current Address:
Previous Address:
Time at Previous Address (If less than 3 years):
Current Employer:
Occupation:
Years in Current Role:
Current Employer Address:
Previous Employer (if current employer is less than 3 years):
Occupation:
Years in Previous Role:
Previous Employer Address:
Nearest Relative or Contact (not living with you):
Phone:
Relationship:
Address:
Previous Consumer Credit With 1:
Previous Consumer Credit With 2:
Bank Account and Insurance Company Details
Account No. for Payments:
Bank:
Name of Vehicle Insurance Company:
Policy Number (if known):
Assets
Home (joint family home) ($):
Investment Property ($):
Furnishing ($):
Bank ($):
Investments ($):
Motor Vehicles ($):
Other ($):
Other ($):
TOTAL ($):
Liabilities/Expenses
Mortgages—Balance ($):
Rental ($):
H/P or Credit Accounts ($):
Credit Cards ($):
Personal Loans ($):
Bank O/D ($):
Other ($):
Other ($):
Take Home Income (i.e. net after tax)
Applicant 1 – Average Take Home Pay ($):
Applicant 2 – Average Take Home Pay ($):
Rental Income (if applicable) ($):
Other Income (please specify) ($):
Other Income (please specify) ($):
Source of Other Income:
THE PRIVACY ACT 1993

I/We authorise Blackwell Motors Limited together with any credit/finance provided to collect, retain and use personal information about me/us, for the purposes of:

  • Assessing my/our credit worthiness, attending to the financing, whether directly or indirectly, of my/our contract(s);
  • Marketing and/or informing me/us about the goods and services provided by Dealer and credit provider.

I/We authorise any credit provider to collect from credit reporting agencies, credit providers, my/our employer(s), accountant(s), relatives, or other person(s) such personal, financial and commercial information about me/us to access this application. Furthermore I/We authorise this information be provided to credit agencies for the purpose of maintaining proper or effective records. I/we acknowledge failure to provide or disclose information requested on this application may result in my/our application for finance being declined. I/We warrant that the information provided in this application is true and correct.

Applicant 1
Applicant 2
Finance Required For
Vehicle:($)
Value:($)
Deposit:($)
Trade:($)
Make:
Model:
Rego:
Trade Description:
Money Owing on Trade ($):
Finance Company:
Is there a salesperson that you’ve been dealing with?:
Preferred Location:
Preferred Options (Term):
Balloon Payment ($):
I/We authorise the above finance company to disclose to Blackwell Motors Limited any details required on my/our finance contract, including the current settlement figure and structure of current loan.
Yes