Autozone Finance

Finance Application Form

Applicant:	(SURNAME)	(FIRST NAMES)
Marital Status:		Number of Dependants:
Spouse's Name:	(SURNAME)	(CHRISTIAN NAMES)
Date of Birth:	(APPLICANT)	(SPOUSE)
Driver's Licence No:	(APPLICANT)	(SPOUSE)

FULL RESTRICTED LEARNERS

Current Address:
Years At Address:
Tenancy:	OWN HOUSE RENTING BOARDING FAMILY HOUSE
Tenancy:	OTHER
Other (Detail):
Previous Address:
Years At Address:
Email Address:

Phone: (PRIVATE) (BUSINESS) (MOBILE)

Present Employer:		Years:
Address:		Occupation:
Phone:
Previous Employer:		Years:

Spouse's Employer:		Years:
Address:		Occupation:
Phone:

Parents Name/Nearest Relative:
Address:
Phone:
Relationship:

Parents Name/Nearest Relative:
Address:
Phone:
Relationship:

Account References:	(1)
	(2)

Bank:

Account No:

Approximate Amount Required: $

ASSETS	(please note all assets which are jointly owned)	joint	LIABILITIES
HOME	$		MORTGAGES	$
FURNISHINGS	$		HP/CREDIT ACCOUNTS	$
BANK	$		BANK O/D	$
CAR	$		OTHER CREDITORS, LOANS	$
INVESTMENTS	$
OTHER	$		TOTAL	$

TOTAL	$		NET WORTH	$

INCOME (monthly)		EXPENSES (monthly)
AVERAGE TAKE HOME PAY	$	MORTGAGES/RENT PAYMENTS	$
SPOUSE'S TAKE HOME PAY	$	HP AND CREDIT ACCOUNTS	$
OTHER INCOME	$	RATES, PHONE, POWER, INSURANCE	$
		LIFE INSURANCE/BUILDING SOCIETY	$
TOTAL	$	CAR AND OTHER EXPENSES	$

		TOTAL	$

Information Statement/Authorisation Pursuant To The Privacy Act 1993
Please read this statement/authorisation notice in full.

Have you ever had or are there now any attachments or legal proceeding against you,
or any action for payment default?

Yes No
If yes, please state details:

Is finance for business purposes? Yes No

If GST registered, is the level of taxable supplies made by you more than 75%
Yes No N/A

I/We declare the above information is true and correct and that I/we are over the age of 18 years and I am/we are not an un discharged bankrupt/s. I/We authorise Autozone and any finance company to which this application has been forwarded to contact any credit reporting agencies, credit providers, my employers, accountants or any other source, to obtain, check and exchange (both now & in the future) such personal, financial and commercial information as may be required for the purposes of considering this application, the protection and administration of any loan arising out of this application and to assist in the enforcement of any agreement between me and any finance company. I/we agree that you may produce this authority to such parties for the purposes of collecting such information.

I agree that the information in connection with this finance application may be transmitted via facsimile and/or electronic mail, and I acknowledge that there may be some security risks associated with the transmission.

I have read and accept the terms and conditions within this informative statement/authorisation.

I Accept Terms And Conditions

Please ensure the details you have provided above are correct before submitting the application.