Self Employed Loan Data Collection Form

RedCap Finance Brokers

Self-Employed / Business Owners Loan Data Collection Form
Type of Loan Required

Business Loan - UNSECURED SHORT TERM Business Loan - SECURED SHORT TERM (24 Hrs) Business Loan - Equipment Funding Business Loan - Vehicles Business Loan - Construction Business Loan - Development Business Loan - Commercial Property Business Loan - New Business Startup Options Business Startup - CONSULTATION Business Tuneup - CONSULTATION Self-Employed Home Loan Investment Loan Personal Loan
Your Personal Details
Title: *
Your Preferred Title
Name *

First Name Last Name
Birth Date *

Day Month Year
Marital Status: *

Single Married Defacto Separated
E-mail *
Best Contact Email Address
Phone *

Area Code Phone Number
Mobile Phone *
Address *

Street Address

Street Address Line 2

City State

Zip Code
How long have you lived in your given address? *

0-1 Year 1-2 Years 3-4 Years 5+ Years
Take An ID Photo (of Yourself Holding Your Current Photo ID)
Your Business Information
Business Name *
ACN (if Applicable)
ABN *
Registered for GST *

Yes No
Owners' Name/s *
Industry
Years in Business *
Ownership Structure *

Sole Trader Partnership Private Company Public Company Discretionary Trust with Company Trustee Discretionary Trust with Individual Trustee/s
Business Story
Loan Size Requested? *
The amount you would like to apply for
Business Gross monthly income *
The total amount you earn that is provable by your Bank Statements.
How Urgent is Funding Required

24-36 hours 1-4 weeks 1-6 months
Have you applied elsewhere for this funding, Please explain in full.
Your Personal Employment Information
Present Employer *
Occupation *
Years of experience *

0-1 Year 1-2 Years 3-4 Years 5+ Years
Gross monthly income *
The amount you get BEFORE you pay TAX or any other deductions.
Monthly rent or mortgage payments *
Multiply Your weekly amount x 52 and divide by 12
Total Credit Card Limits *
Add up the limits on all of your credit cards, store cards (Not what you owe)
Total Monthly Repayments for all other loans *
Multiply Your weekly amount x 52 and divide by 12
Genuine Savings *
Amount you have saved that is in your Bank Account
Gifted amounts to be used for your deposit *
Non-Repayble Gifts that are evidenced by a Statutory Declaration
Borrowed Deposit Amount *
Repayable gifts/loans that you can use for your deposit
Comments:
I authorise RedCap Finance Brokers and their associated third party referral partners to obtain and share personal and credit information about me from my employer and credit bureau, or credit reporting agency, any person who has or may have any financial dealing with me, or from any references I have provided. This information, as well as that provided by me in the application, will be referred to in connection with this loan application and any other relationships we may establish from time to time whether by mutual thrid party agreement or required to by law. Any personal and credit information obtained may be disclosed from time to time to other lenders, credit bureaus or other credit reporting agencies. *

YES NO
I hereby declare that the information given by me is true, accurate and complete as of the date of this application submission. *

YES NO
Enter the message as it's shown to verify that you agree to submit your personal information to us. *
RedCap Finance Brokers. Allan Pearson Authorised Credit Representative 523250 of Australian Credit Licence 392611
Should be Empty:

RedCap Finance Brokers

Your Personal Details

Your Business Information

Your Personal Employment Information