Application For Credit

FLEXIPAY CREDIT CARD
THESE STORES
ACCEPT FLEXIPAY
APPLICATION FORM
HOW TO PAY US
CONTACT US
PROBLEMS OR
COMPLAINTS
CURRENT PROMOTION
(WIN 500 EVERY MONTH)
 
TE HURUHI FINANCE
Personal Loans &
Vehicle Finance
THE FLEXIPAY STORY

Please fill out the form fields below & click the submit button when finished.
Press the tab key to move to next field.
All fields are compulsory.

Alternatively you can download the form, print it out and fax it to 372 9049.

Click here to download application form (PDF format).

Click here to download Adobe Acrobat Reader.


Personal
 Details

Personal Loan
Loan Amount    

Credit Card
Credit Limit Required  


 

 

Purpose of Loan (Full Details)

Title

Surname

First Names

Date of Birth

Maiden or Other Surnames

Marital Status

Home Phone

Mobile Phone

Work Phone

Email Address

Accommodation

No. of Dependants

Home Address

How long at Home address?

Previous Address:

How long at Previous address?

Drivers License Number

Drivers License Version

Employment
 Details

Current Employer Name

Address

Phone

Occupation

Length of Service

Employer's email address

Type of employment

Do you have the details of your previous employer?

yes       no

Previous Employer Name

Previous Employer Address

Previous Employer Phone

Previous Employer Occupation
 

Previous Employer Length of Service

Contacts

Next of Kin Name (at a different address)

Relationship to you

Address

Phone

Other relative or close friend (living on Waiheke)

Relationship to you

Address

Phone

Do you have a spouse or de-facto partner?

  yes       no

Spouse

Full name of Spouse / De-Facto Partner

Date of Birth

Occupation

Phone

Mobile

Email

Employer

Length of service

Employer Phone

   

Consent Consent to terms and use and disclosure information

Upon submitting my application,
I consent to the above terms: