Amount to consolidate ($) *
Enter amount in dollars. An estimate is OK if you don't know the exact amount.
Type of loan *
Debt Consolidation
Consolidate with mortgage
Not sure
Enter preferred type of consolidation
Your details
Your name *
First
Last
If you prefer not to enter your last name, please enter an initial only.
Email address
If we need more details at a later stage, we may contact you by email as well as by phone.
Best phone contact *
Enter the best phone number to contact you here.
Home phone
Leave this field blank if you entered your home phone as the Best Phone to contact you.
Work phone
Leave this field blank if you entered your work phone as the Best Phone to contact you.
Mobile phone
Leave this field blank if you entered your mobile phone as the Best Phone to contact you.
Your employment details
Employment status *
Full time
Part time
Casual
Contract
Pensioner
Unemployed
Other
Enter your employment status
Employment length *
Less than 3 months
3 - 6 months
7 -11 months
1 year
2 years
3 years
4 years
5+ years
How long have you been employed at your current work place?
Your income ($) *
Income per week before tax
Your partner's income ($)
If you are applying with your partner, enter his or her income in this field.
Financial details
Number of applications *
None
1
2
3
4
5+
How many times have you applied for a loan in the last 6 months?
Existing credit defaults *
None
Paid defaults
Unpaid defaults
Unpaid and paid
Do you have any PAID or UNPAID defaults? (credit card, loans, phone, electricity, store cards, etc)
Existing Unsecured loans ($) *
Total amount of your current UNSECURED debts in dollar value. (credit cards, personal loan, bills, phone, electricity, etc)
Existing Secured loans ($) *
Total amount of your current SECURED debts in dollar value. (car loans, home loans, boat loans, equipment loans, etc)
Do you own real estate? *
Yes, with a mortgage
Yes, i own it outright
No
Enter your property details
Mortgage amount ($)
If you have a mortgage, how much do you owe to the bank?
Property value ($)
If you have a property (house, unit, commercial building, land), what is the current value of the property. An estimate is OK.
Current interest rate (%)
If you have a mortgage, what is the interest rate?
Comments
Enter any additional details in this field.
Type the letters you see in the image below.
