Welcome to the Leasepac online application form

Please fill out the following information and select the send button at the end of the form. We will respond to your submission within 24 hours.

Please ensure that as much information as possible is filled out before you press the send button.  

Leasepac respects the users that access this site and will not disclose any private information
submitted unless required to do so by law.
Our policies regarding your information are strict and comply with with current privacy laws.

1. LOAN DETAILS

Amount Required
Purpose of Loan
Loan Type
Term Required
years

Business Purchase or Franchise Purchase.
Please Complete the Following, otherwise go to Section 2.
Registered Name
Type of Business
Address   Street & No
 Suburb....
State ... P'Code
Purchase Price
Less Cash Provided by Applicants
Less Other Borrowing
TOTAL Amount Required

2. CORPORATE BORROWERS

Only Complete this Section if you are taking the loan out in the name of your company.
If you are applying as an individual, partnership or sole trader please proceed to section 3.

Company Name:
A C N No.:
Date of Incorporation:
Registered Address: Street & No
 Suburb....
 State . . P'Code
 
Principle Activity:
Name of Trust:

3. PERSONAL PARTICULARS OF DIRECTORS/SHAREHOLDERS/BORROWERS

PERSONAL DETAILS
APPLICANT 1
APPLICANT 2
Surname:
Other Names:
Date of Birth:
Marital Status:
Present Address:
Street & No
Suburb

. State ......
P'Code No of years
Street & No
Suburb

. State ......
P'Code No of years
Email Address
Tel. No. Home:
Mobile Number
Tel. No. Office
Fax No.:
Occupation

Employed by:
No. of years
years
years
Annual Gross Inc
Other Information:

4. CONTACTS

Accountant:
Address: Street & No
 Suburb...
. State .. . P'Code
Contact:
Telephone:
Solicitor:
Address: Street & No.
 Suburb...
. State .... . P'Code
Contact:
Telephone:
Bank:
Branch:

5. STATEMENT OF ASSETS AND LIABILITIES

ASSETS
Family Home
2nd Property
Car 1
Car 2
Savings    
Other Savings
Deposit Paid
Superannuation
Furniture & Personal Effects
Other
TOTAL ASSETS

LIABILITIES

Home Mortgage
Mortgage Payment
 p/ m
Mortgage 2
Mortgage Payment
 p/ m
Car Loan
Car Payment
 p/ m
Car Loan 2
Car Payment
 p/ m
Personal Loans
Personal Loan Payment
 p/ m
Credit Card Credit Card Payment p/ m
Credit Card 2 Credit Card Payment p/ m
Other Other Payments p/ m
Current Rent Paid
Bank Overdraft
Limit
 per month
Other Liabilities
TOTAL LIABILITIES

SURPLUS
(ASSETS LESS LIABILITIES)

Other Comments/Information/Questions:

I/WE CERTIFY THAT ALL THE ABOVE DETAILS ARE TRUE AND CORRECT

Please note that upon receipt of this application we will respond to you within 24 hours and may require additional information. If additional information is required we will inform you as to the best means of delivery.