.
DEBT CONSOLIDATION
.
How much you need to consolidate ( $ ):
Type of loan:
Debt Consolidation
Refinance
Other
.
Title
Select One
Mr
Mrs
Miss
Ms
Dr
First name:
Last name:
Your email:
Home phone number:
Work phone number:
Mobile phone number:
How many
times have you applied for a loan in the last 6 months?
Select One
None
1
2
3
4
5 or more
Do you have
any PAID or UNPAID defaults? (loans, credit card, phone,
electricity bills, etc)
Select One
None
Paid
Unpaid
Both
Total amount
of your SECURED debts ($)
Total amount
of your UNSECURED debts ($)
Your income
before tax ($)
Select One
week
fortnight
month
year
Do you own
property or have a mortgage?
Select One
Yes
No
If you have
a mortgage, with which bank?
Select One
Commomwealth Bank
Natioanal Australia
Bank
Westpac
ANZ
Adelaide Bank
Bank of Queensland
Bendigo Bank
St George
Building Society
Other
What is
your employment status?
Select One
Full time
Part time
Casual
Contract
Pensioner
Unemployed
How long
have you been employed at your current work place?
Select One
1 month
2 months
3 months
4 months
5 months
6 months
7 months
8 months
9 months
10 months
11 months
1 year
2 years
3 years
4 years
5 years
6 years
7+ years
Comments:
Optional
