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...for '2010 Mitsubishi Triton 4WD 2.5D D/CAB GLX M'

Fill in the form below to start your finance application. Return to listing. Fields denoted * are required.

» Personal details

First Name *

Middle Name

Last Name *

Preferred Name

Gender *

NZ Resident *

Passport Number *

Work Visa Expiry Date *

Date of Entry to NZ *

Date of Birth *

Format: dd/mm/yyyy

NZ driver license no. *

License Type *

License Restrictions

License Version no. *

License Issue Date *

Format: dd/mm/yyyy

License Expiry *

Marital Status *

How Many Dependants *

Children etc...

» Contact Details

No. *

Street *

Suburb

Town/City *

Postcode *

How long at this address? *

Situation *

Email *

Mobile phone *

Home Phone

Work Phone

» Previous Address

No. *

Street *

Suburb

Town/City *

How Long? *

Example: 2 and a half years.

» Current Employment Details

Employment *

Current Employer *

Occupation *

How Long?*

» Previous Employment Details

Employment *

Previous Employer *

Occupation *

How Long?*

» Nearest relative/other contact (not living with you)

First Name *

Last Name *

Relationship *

Mobile phone *

Home Phone

» Second contact (not living with you)

First Name *

Last Name *

Relationship *

Mobile phone *

» Payment Details

Bank account no.*

Payment Frequency *

First payment date *

Format: dd/mm/yyyy

Account Name *

Bank *

Branch *

Preferred Repayment Term *

» Assets (what you own, do not enter $ or ,)

Property

Vehicle

Bank

Investments

Other

» Liabilities (what you owe, put 0 if none, do not enter $ or ,)

Mortgage / Rent *

Per Month

Vehicle Loan *

Overdraft *

Rent/Mortgage Payment Frequency*

If Weekly, Enter The Amount

Credit Cart *

Other

» Existing Loan (what you owe, do not enter $ or ,)

Loan Amount

Amount Outstanding

Monthly Repayments

» Household Income (monthly, put 0 if none, do not enter $ or ,)

Your take home pay *

Partner take home pay *

Other income

Your Pay Frequency*

Partner Pay Frequency*

» Expenditure (monthly, put 0 if none, do not enter $ or ,)

Rates and Utilities

Transport Expenses

Insurance Payments (excluding life or health insurance)

Health Care and Pet Care Costs

Private School Fees

Groceries

Memberships Subscriptions

General Child / Dependent Expenses

Health/Life Insurance Payments

Child Support Payments

» Supporting documents attached

You may be required to submit further identification details such as a bank statement, driver license or other(s) after you submit this application.

» Acknowledgement

I agree with the below statement...

I understand that:

Acceptance of this application does not necessarily mean that you will grant the credit applied for, and you may decline this application without giving any reason; and
I may contact your Privacy Officer to request access to and correction of any information about me that you hold and you will supply to me on request the names and addresses of any agencies to whom you have disclosed information about me.
U-Sell may nominate a third party to supply the credit for which I am applying for, and therefore the term "you" implying U-Sell also refers to the nominated third party.

I authorise you to:

use information disclosed in this application for the purpose of processing this application and sending me information about other products offered by U-Sell;
make all such enquiries about me and my financial affairs as you consider appropriate in relation to this application (and further enquiries in the future which may be necessary in connection with this application and any subsequent requests for credit) and to disclose details of this application to any person for this purpose. I authorise any party approached by you to disclose such information to you; and
disclose details of this application and of any resulting contract to any assignee of any such contract or to any credit agency, debt collector or solicitor. I understand that the assignment of any such contract may result in the existence of that contract being noted on a public register.

I certify that:

where I have provided information in this application about any other person, that person has authorised me to disclose the information to you and to authorise you to use and disclose that information in the same ways as if that person was an applicant; and
the information provided in this application is true, correct and complete, and no information that would be relevant to you in evaluating the application has been omitted. If any relevant changes occur between now and signing a credit agreement with you, I will disclose such changes to you immediately.

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...for '2010 Mitsubishi Triton 4WD 2.5D D/CAB GLX M'