Debt Consolidation Australia - Online Assessment Form

1. Loan Amount


Amount You Wish To Consolidate *

2. Credit Cards & Store Cards

How Many Credit Cards / Store Cards Do You Have :

Card Type *	Outstanding Balance *	Credit Provider *
	$
	$
	$
	$
	$
If you have more credit cards / store cards list them in Additional Notes

3. Personal Loans & Car Loans

How Many Personal Loans / Car Loans Do You Have :

Loan Type *	Outstanding Balance $ *	Credit Provider *
	$
	$
	$
	$
	$
If you have more personal loans / car loans, list them in Additional Notes

4. Real Estate Assets

How Many Real Estate Assets Do You Have :

	Value Of Real Estate Asset $*	Outstanding Mortgage $*
1	$	$
2	$	$
3	$	$
4	$	$
5	$	$
If you have more real estate assets, list them in Additional Notes

5. Employment Details


Do You Work Fulltime *
Are You Self-Employed *
Do You Have Full Financials For Last 2 Years ? *
How Long Have You Been With You Current Employer or Self Employed ? *

6. About Your Credit History


Do You Have Late Payments / Defaults / Arrears *
If "Yes" please describe in details

7. Contact Details


First Name *
Last Name *
Street Address*
Suburb*
State*
Post Code*

Home Phone *	()	* Please provide at least 2 contact numbers
Work Phone *	()
Mobile *
Email *
Preferred Contact Time *
Additional Notes:

Please enter the *
verification number

Debt Consolidation Loans Australia Online Assessment Form