Loan account number:

 


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  Mortgage House Leasing
   
 
Full Name of Applicant
Trading as/ as Trustee for
    
Phone (business)
    
Phone (home)
    
Fax
    
E-mail
    
     
  Asset to be financed:  
Full Description
    
Make
    
Model
    
Year
    
New
  
Used
 
Replacement
  
Additional
 
  For Motor Vehicles:  
Manual
  
Automatic
 
Air Condition
  
Alloy Wheels
 Sunroof
 
Other (describe)
    
  Type of finance:  
Lease
  
Novated Lease Commercial Hire Purchase
 
:
   Private Sale :  
Yes
 
No
 
  Supplier:  
Name of Supplier
    
Contact
    
Phone
    
Fax
    
E-mail
    
  Purchasing from a Dealer with ABN number:  
yes
  
No
 
     
State in which client is located
    
Term:
  
36 month
48 month
 60 month
 
Residual Value $
  
or
 % of asset cost
 
Asset Cost $
(incl. GST)
  
GST on asset cost
(if known)$
 
  Payments:  
Monthly
  
Quarterly
 
Semiannually
  
Annually
 
  Commercial Hire Purchase ONLY: Deposit if any  
By way of Cash $
  
Or Trade In $
 
     
Preferred Form
of Contact
    
     
   

 

 




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