Bad Credit Form

Section A — Personal Information

Full Name (required)

Email (required)

Mobile Number (required)

Date of Birth (required)

Residential Address (required)

Living Situation (required)
OwnRentLiving with Family

Time at Address (required)

years
  months

Section B — Employment & Income

Employment Type (required)
Full-TimePart-TimeCasualSelf-EmployedUnemployedCentrelink

Employer/Business Name

Occupation / Role

Length of Employment (years)

Gross Monthly Income ($) (required)

Section C — Loan Details

Loan Type (required)
PersonalCarRecreationalDebt ConsolidationBusiness (Sole Trader)

Purpose of Loan (required)

Loan Amount ($) (required)

Preferred Term (required)
24 months36 months48 months60 months72 months

Deposit (if any)

Vehicle / Item Make

Model

Year

Purchase Type
DealerPrivate Sale

Section D — Credit History (Bad Credit Context)

Have you had any of the following?

DefaultsLate paymentsPart IX debt agreementBankruptcy (discharged)Court judgmentPrevious decline

Approx. Credit Score (if known)

Time Since Last Event (months)

Current Loans / Repayments (brief)

Explanation (what happened?)

Supporting Uploads (quotes, payslips, bank statements, ID)

Section E — Consent

I confirm the above details are accurate.

I agree to the Privacy Policy and Credit Disclosure Statement.

I consent to electronic communication and soft credit checks to assess my options.

Section F — Submit