Please complete the information below.
Do you require a mortgage broker?
YES NO
1 - Personal Details
First name*:
Surname*:
Street address 1*:
Street address 2:
City*:
Postcode*:
Phone number*:
Mobile number:
Email address*:
2 - Asset Details
Employment type:
Select one... Part Time Full time Casual Contract Self Employed
Gross Salary:
Other income:
Total value of properties:
Total value of other major assets:
Total of existing loans:
Total of credit card limits:
What are you borrowing for:
Features you would like:
Internet Banking Extra Loan Repayments Interest Only Branch Banking 100% offset facility Line of credit Fixed rate Low rate for 1 year Re-draw facility Credit Card facility
3 - Other
Has anyone ever started legal action against you because you did not pay an amount due?
Would you prefer a broker contact you without completing Asset Details above?
YES NO (If yes, please ensure you complete 1-Personal Details above)
