Customer Contact Name:

*

Date (dd/mm/yyyy):

/ /

Phone Number:

*

Borrowers Name:

Email Address:

*

Is there a Trust involved?

Yes No

If "Yes" please specify the name of the trust:

Business Established (no. of years):

Amount Required:

Purpose:
(include detailed breakup of ‘Amount Required’ above)

If Purchasing Commercial Property / or if Commercial Property related:

Is GST payable on purchase?

Yes No

Owner Occupied or Tenanted?

[Please Select] Owner Occupied Tenanted

If Tenanted:

Name of Tenant:

Term of Lease (years):

Facility Type Required: (eg. Overdraft, Line of Credit, Term Loan, Other)

Term Required (years):
Max. 20y (P&I), 5y (I/O)

Repayment Basis:

[Please Select] Interest Only Principal & Interest Other

Interest Type:

Security Offered:
(eg. residential, commercial, industrial, warehouse, retail, office, specialised)

Registered owner:

Address:

Description:

Estimated Value of Security:

Basis of Estimate:
(details of client or other)

If Refinancing:

Current Lender:

Reason for Refinance:

Has Approach been made to other Lenders?

If so, who?

Was an offer made?

Yes No

Are there any Lenders borrower does not want us to approach?

Additional Notes