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Trading Name of Business
State Business Lic N#
Address
Suburb
State
Postcode
Email
Phone Number
Type of Funding
General Factoring Only
General Factoring and Parts Funding
Type of Entity
Trust
PTY LTD
Partnership
Sole Trade
PTY LTD Company Name if Available
ABN/ACN
Please supply details of Owner, (If, Sole Trader), Partners, (If Partnership), Directors (If Company), If Trustee (Trust)
Owner/Partner/Dirtectors Name
Type of owner as identified Above:
Owner
Partner
Director
Home Address
Residential Status
Own Home
Rent
Home Phone Number
Position in Company
Date of Birth
Driver’s Licence No
Years in Current Business:
Years Management In This Business
Current business existing for:
Total Number of Employees
The position of outstanding taxes at: ....../...../.....
Group Tax Current Owing
GST
Branch
Size of Premises
Lease
Own
Booth/Oven
Yes
No
Age of Booth
Quoting Computerised System
Lease/Own
Lease
Own
BSB
System Brand
Account No:
Lease/Own
Lease
Own
FlexiQuote AutoQuote Quickquote
FlexiQuote
AutoQuote
QuickQuote
Average sales per month, excluding non approved work:
Total Sales Per Month ($):
Bank
Account Name
Percentage Intended to Factor (%):
Which insurance companies are you a ( Prefered, Guaranteed or Authorised Repairer for? Please list:
Which Car Manufacturers are you an approved Repairer for? Please List:
I / We hereby apply for an Aussie Factors Pty Ltd credit facility. I/We have read and understood the particulars which have been completed in this form, and declare that they are true and complete. I / We hereby acknowledge and agree as follows: Acknowledgement and Consent That Credit Information May Be Given to a Credit Reporting Agency I/We acknowledge that the Privacy Act (the Act) allows Aussie Factors Pty Ltd to give a credit reporting agency certain personal information about me / us which I / we authorize Aussie Factors Pty Ltd to do so. This information includes: Information about me / us which will allow me / us to be identified. The fact that I / we have applied for credit and the amount. The fact that Aussie Factors Pty Ltd purchases invoices and does not provide cash, credit, or finance. Details of payments which become overdue more than 90 days and for which collection action has commenced. Advice that payments are no longer overdue. That in Aussie Factors Pty Ltd's opinion I/we have committed a serious credit infringement. That the debts funded to me / us by Aussie Factors Pty Ltd have been discharged. Authority for Aussie Factors Pty Ltd to Obtain Certain Credit Information To enable Aussie Factors Pty Ltd to assess my / our application for commercial credit, I / we authorize Aussie Factors Pty Ltd to: Obtain from a credit reporting agency credit reports containing personal credit information about me/us and about my/our commercial activities or commercial credit worthiness. Obtain from my/our accountant such financial information as Aussie Factors Pty Ltd may require. Authority to Exchange Information with Other Credit Providers I / we authorize Aussie Factors Pty Ltd to give and obtain from credit providers named in this credit application and credit providers that may be named in a credit report issued by a credit reporting agency information about my/our credit arrangements including any information about my/our credit worthiness, credit standing, credit history, or credit capacity that credit providers are allowed to give or receive from each other under the Act.
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