Corlit Computer Systems Application Form

Completing this application does not incur an obligation to proceed with a finance contract. Information given here is used only as a guide to whether finance can be provided.


Application for Finance for Computer Equipment This information is needed so that we can process your application. Three easy steps are involved: You complete the application form below or call 07 3892 6255 at any time to complete an application over the phone. We will contact your next-of-kins and employer to confirm your details and verify your employment Once your application is approved we will contact you to discuss your computer package and to arrange an appointment time for you to collect your new computer.

Marketing
Please let us know where you heard about us.
Other


Applicant
Given Names
Last Name
Marital Status
Partner's Name
Street:
Suburb:
City:
State:
Postcode:
Lived at this Address:
Premises:
Date of Birth:
Home Phone:
Mobile Phone:
Work Phone:
E-Mail:
Previous Address if less then 12 months at current address.
Street:
Suburb:
City:
State:
Postcode:
Lived at this Address:

NEXT OF KIN This information is required in order to verify your details. Your next of kins should be family members related to you but not currently living at the same address as you. They should also not be living with each other.They should be able to confirm your details and current address. Your next-of-kins should live in Australia and be over the age of 18. In the comments sections following each Next of Kin, please indicate any information that might speed your application along e.g. Best time to contact them etc. Two next-of-kins are required for applicants collecting their computers in person. Three next-of-kins are required for mail order applicants and for applicants applying for Plasma's, White Goods and Electronics. (Your address and your Next Of Kins should all be different. We can not process your application until we have all the correct details) *Please note that the fields with an at the end of it is compulsory information.**

PERSON ONE
Given Names	*
Last Name	*
Relationship:	*
Street:	*
Suburb:	*
City:	*
State:	*
Postcode:	*
Home Phone:	*
Work Phone:
Mobile Phone:
Is there anything you want to add about this relation?


PERSON TWO
Given Names	*
Last Name	*
Relationship:	*
Street:	*
Suburb:	*
City:	*
State:	*
Postcode:	*
Home Phone:	*
Work Phone:
Mobile Phone:
Is there anything you want to add about this relation?


PERSON THREE
Given Names	*
Last Name	*
Relationship:	*
Street:	*
Suburb:	*
City:	*
State:	*
Postcode:	*
Home Phone:	*
Work Phone:
Mobile Phone:
Is there anything you want to add about this relation?



Income
Total Income Amount:
Income Source:
Employer:
Employer Phone:
Employed for:

Employer:
Employer's Phone:
Employed for:

Expenses
Rent (in A$):

Debts
	$
	$
	$
	$
	$
	$

Bankruptcy

Have You Ever Been Bankrupt?

Year Of Bunkruptcy

Has Your Bankruptcy Been Discharged?

Previous Credit History

Please Tell Us About Any Previous Problems You Have Had With Credit

Proof Of Identification

Documentation Required Before Receiving A Computer From Corlit Systems

1. Driver's Licence, Learner's Permit , 18+ Card or Passport

2. Recent Bank Statement or Transaction History from the account you wish to have debited

3. Two bills in your name and address (3 bills required for Mail Order)

4. A Copy Of Your Residential Lease (or letter from landlord) / rates notice

5. Medicare Card

Computer Package Choice

Please make your selection

Standard Package plus: Extras Upfront Cost

Printer None

Scanner None

512meg RAM None

128mb Video None

80gig HDD None

NOD32 Antivirus $64.50

Choose this option for Laptop:
Laptop None

Plasma, White Goods or Electronics:
Other None

Please note that brands of Plasma entertainment packages are chosen by our purchasing manager. Alternative brands are available at an extra cost to the customer. To apply for entertainment packages, white goods and electronics, you must have a good credit history and agree to have a credit check. Completing this application does not guarantee finance.

If you ticked "Other" Please indicate here: Model Number, Brand, Size, Colour and any information that may help us find what you are applying for.

Comments/Notes

Completing this application does not incur an obligation to proceed with a finance contract. Information given here is used only as a guide to whether finance can be provided.

NEXT OF KIN

Back to Home Page PO Box 311, Wellers Hill, QLD 4121 Shop 3/15 Denham Tce, Wellers Hill, QLD 4121 Ph: (07) 3892 6255; Fax: (07) 3892 6727 ABN:11 419 124 886 Email Us

Back to Home Page
PO Box 311, Wellers Hill, QLD 4121
Shop 3/15 Denham Tce, Wellers Hill, QLD 4121
Ph: (07) 3892 6255; Fax: (07) 3892 6727
ABN:11 419 124 886
Email Us