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• How much would you like to borrow?*
  Please enter a number greater than or equal to 2000.

• What is the purpose of your loan?*
  • 
    Debt Consolidation
  • 
    Vehicle
  • 
    Unexpected Expenses
  • 
    Other

• Have you found the vehicle already?*
  • 
    Yes
  • 
    No

• How much do you earn?*
• Frequency*
  WeeklyMonthlyAnnual

• Do you have any paid or unpaid defaults in the last 12 months?*
  • 
    Yes
  • 
    No
  • 
    Unsure

• Are you currently employed?*
  • 
    Full Time
  • 
    Part Time
  • 
    Self Employed
  • 
    Other

• How long have you been in your current role?*
  • 
    Less than 1 year
  • 
    1 year
  • 
    2 years
  • 
    3 years+

• What is your living situation?*
  • 
    Home Owner
  • 
    Renter
  • 
    Other

• How long have you been at your current address?*
  • 
    Less than 1 year
  • 
    1 year
  • 
    2 years
  • 
    3 years+

• Would you prefer to make loan repayments weekly or fortnightly?*
  • 
    Weekly
  • 
    Fortnightly

• Thanks, let’s put a name to this

• First name:*
• Last name:*
• Your email:*
• Your phone number:

• How do you identify?*
  • 
    Male
  • 
    Female
  • 
    Other

• Marital Status:*
  • 
    Single
  • 
    In a relationship
  • 
    Married

• My date of Birth:*
  Day12345678910111213141516171819202122232425262728293031

  Month123456789101112

  Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

• Resisdency status*
  • 
    NZ Citizen
  • 
    Permanent resident
  • 
    Work Visa
  • 
    Student Visa

• What is your address?*
  
  
  Street Address
  
  
  Address Line 2
  
  
  City
  
  
  Post Code
  

• Consent*
  • 
    I declare that I / we have read, understood and accept the privacy declaration. And that all the information contained in this application is true and correct. I / we also declare that I / we are over the age of 18 and are not an undischarged bankrupt.