Apply for finance WIth global credit and Millars Car Center

Applicant Name *

First Name

Last Name

Gender

Male

Female

New Zealand Resident

Yes

No

Relationship

Married

Defacto

Divorced

Separated

Single

Other

Applicant's Date of Birth *

(Month, Date, Year)

MM

DD

YYYY

Tenancy

Own House

Renting

Boarding

Family

Other

Next of Kin *

This will be used as a reference for your application. It must not be the co-borrower if this is a joint application.

First Name

Last Name

Co-borrower's Name

(if applicable)

First Name

Last Name

Co-borrower's Date of Birth

(if applicable)

MM

DD

YYYY

Full-time

Part-time

Self Employment

Contractor

Casual

Beneficiary

PRIVACY ACT

Have you ever had or are there now any attachments, legal proceedings against you, or any action of payment default? If yes, state details in notes above.

Yes

No

Declaration *

I agree to the Privacy Act above and allow Global Credit to perform the required background checks to apply for finance on my behalf.