Disclaimer

I Certify That I Am Above 20 Years Of Age And If I Am Not I Have A Parent And Or Guardian As A Joint Applicant

I / we certify that (I am not / neither of us is) an undischarged bankrupt or liable to any proceedings under the Insolvency Act 1967 and its amendments. I/ we acknowledge that the representations made by me / us in this application have been made to Quick Cash Finance Limited to enable it to determine whether or not to grant credit to me / us and if any relevant information is withheld it may result in this application being declined. I / we authorise Quick Cash Finance Limited to make any enquiries relevant to the statements given in this application, which it may consider necessary, and for that purpose to disclose to and seek from any bank, financial institution, lender, accountant, solicitor, adviser and/or other party any additional information including details of my account or financial affairs and I / we authorise any party approached to provide such information to Quick Cash Finance Limited. I / we authorise Quick Cash Finance Limited to disclose my / our personal information to credit reporting agencies and (if necessary) to any person Quick Cash Finance Limited may appoint to collect any outstanding address. I / we authorise the use of electronic recording devices to collect and store personal information relating to this credit application.

I Certify That I Have Read The Information You Need To Know Page

Personal Details

First Name

Middle Name

Last Name

Gender

Date Of Birth (dd/mm/yy)

Email Address

Home Phone Number

Mobile Phone Number

Work Phone Number

Preferred Contact Method

Preferred Contact Time

Marital Status

Number of Dependants

Driver Licence Number (e.g. BM987654-002)

Current Address You Are Living At eg: 12 George Street Blenheim New Zealand

Time At Address

Residence Type

Previous Address eg: 12 George Street Blenheim New Zealand

Loan Details

Have You Previously Had A Loan With Quick Cash Finance Limited?

Amount Wanting To Borrow (e.g. $1000)

Purpose For Loan

Loan Repayment Term

Do You Require Payment Protection Insurance?

Joint Applications

This Is A Joint Application
Primary Applicant And Co Borrower Reside At The Same Address

Full Name Of The Joint Applicant

Security (Motor Vehicle / Boat / Caravan Only)

Only Fill Out These Sections If You Intend To Use A Motor Vehicle / Boat / Caravan For Security Against Your Loan.

Who Owns The Security?

Is There Any Money Owed On The Motor Vehicle / Boat / Caravan

Make Of Motor Vehicle / Boat / Caravan

Model Of Motor Vehicle / Boat / Caravan

Year Of Motor Vehicle / Boat / Caravan

Registration Number Of Motor Vehicle / Boat / Caravan

Colour Of Motor Vehicle / Boat / Caravan

Insurance Company Of Motor Vehicle / Boat / Caravan

Security (Real Estate Only)

Only Fill Out These Sections If You Intend To Use Real Estate For Security Against Your Loan.

Address Of Real Estate (If To Be Used For Security)

Whose Name Is Real Estate In? (If To Be Used For Security)

Occupation Details

Occupation

Employer

Employers Phone Number

Years With Same Employer Or Unemployed

Previous Employer

Previous Employment Length

Authenticity Verification