Application For Credit

Please fill out the form fields below & click the submit button when finished.
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Alternatively you can download the form, print it out and fax it to 372 9049.

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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?

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

Employer

Length of service

Employer Phone

Credit
History

Name of Finance Company/Lender number 1

Account Number

Type of Credit

Date Commenced / Period

Remaining Balance

Do you have details of another Finance Company or lender?

yes no

Name of Finance Company/Lender number 2

Account Number

Type of Credit

Date Commenced / Period

Remaining Balance

Credit Card details

Credit Card Type

Issuing Bank

Year of Issue

Total Limit

Remaining Balance

Assets and
Liabilities

Assets

Make/Model of Motor Vehicle if owned

Registration Number

Year

Financed By

Liabilities

Mortgage/Rent/Board (Weekly)

Motor Vehicle Payments (Weekly)

Loan/Hire Purchase (Weekly)

Credit Card Repayments (Weekly)

This Loan(Weekly)

Total Liability Payments (Weekly)

Please include additional Comments here

Financial

Insurance

Do you have private insurance that will cover the goods being purchased? If so, please enter:
Insurance Company

Do you have any form of insurance covering loss of earnings and/or ability to earn? If so, please enter:
Insurance Company

Income And Expenditure

Normal Net Wages (After Tax, Weekly)

Spouses Net Wages (After Tax, Weekly)

Regular Household Expenses Weekly)

Consent Consent to terms and use and disclosure information

I warrant that the particulars set out herein are true and correct.

I declare that I am over the age of eighteen (18) years, further, I declare that I have not been adjudged bankrupt, nor suffered any warrant to be levied against me, and that I am not an undisclosed bankrupt.

I accept that this form and the information contained herein shall remain the property of Te Huruhi Finance. I understand that I have the right of access to and correction of my personal information held by Te Huruhi Finance.

I also understand that while outstanding monies are owed to Te Huruhi Finance, even if not overdue, it is my responsibility to inform Te Huruhi Finance of any relevant change in my personal details, including a change of address.

I acknowledge that the information I have provided will be used by Te Huruhi Finance for the purposes of assessing my credit application, administering this and any subsequent contract or credit arrangement with Te Huruhi Finance, and for marketing goods and services provided by Te Huruhi Finance, and I give my authorization for the use of this information for these purposes.

I irrevocably authorize any third party to provide Te Huruhi Finance with such information as is required to assess my application for credit, and further authorize Te Huruhi Finance to provide this information, along with details of any subsequent or past dealings I may have with Te Huruhi Finance, to any third party, for like purposes.

I agree to accept the terms sales as follows: 
1) Payment is due by the 20th day of the month following purchase, except where otherwise agreed; 
2) Interest may be charged on overdue amounts at the rate of 30% per annum calculated and compounded monthly; 
3) Fees may be charged in the recovery of overdue debts; 
4) Goods remain the property of Te Huruhi Finance until fully paid for; 
5) Claims and requests for credit should be made within seven (7) days of invoice; 
6) Returned goods may be subject to a 10% handling and restocking fee; 
7) A credit administration fee may be charged to establish your account, and on individual credit purchases; 
8) Revolving Credit and Fixed Term accounts are charged interest at the rate of 2% per month and 25% per annum respectively.
9) We are obliged , by law, to inform you that should it become necessary to send your account and contact details to a collection agency, all collection costs will be added to your account. Additionally your details may be placed on  shared debtors lists.

I understand that failure to supply the specified information to complete this form may prejudice or preclude the favourable determination of my application for credit.

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