Finance Application – Corporate

Step 1 of 3

Section A. All Applicants to complete (NB – Government entities and public companies only need to complete Section A and authorised officer to sign)
Company Name: (Inc. Trust details)*
ABN*
Trading Name
Date Established*
Address*
State*
Post Code*
Contact Person*
Position*
Phone Number*
Email*
Website
FAX number
Supplier
Supplier Contact
Supplier Phone Number

Section B. Private Companies, Partnerships, Trusts and Sole Traders need to complete Section B as well. For applications over $50,000 ex GST, please attach your last two year’s finalised accounts (Balance Sheet, Profit & Loss and notes to the accounts)
1. DIRECTOR/PROPRIETOR/PARTNER/SELF
Attach Finalised Account Documents
ONLY required for applications over $50,000 ex. GST). Please upload relevant documents for the finalised accounts of your last two years (Balance Sheet, Profit & loss and notes to the accounts).
Drop files here or
Full Name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
*If at current address for less than 2 years please provide previous address

Street Address Address Line 2 State / Province / Region ZIP / Postal Code
Telephone*
Mobile*
Home Ownership (note that the information provided here needs to relate to a property owned or co-owned by the director/proprietor/partner/self).
Valuation ($)
Bal Owing ($)
Lender
Drivers Licence #*
Drivers Licence Expiry Date*
Date Format: MM slash DD slash YYYY
State*
2. DIRECTOR/PROPRIETOR/PARTNER/SELF
Full Name
Date of Birth
Date Format: MM slash DD slash YYYY
Address
*If at current address for less than 2 years please provide previous address

Street Address Address Line 2 State / Province / Region ZIP / Postal Code
Telephone
Mobile
Home Ownership (note that the information provided here needs to relate to a property owned or co-owned by the director/proprietor/partner/self).
Valuation ($)
Bal Owing ($)
Lender
Drivers Licence #
Drivers Licence Expiry Date
Date Format: MM slash DD slash YYYY
State
Accountant
Accountant Name
Phone Number
Brief description of business activities including industry and products / services sold:
No. of employees

Rental Options
AED Unit & Accessories
Product: Monthly Payment (Ex GST) ALL OPTIONAL
- FRED PA-1 Online AED (includes subscription fee to Life DataNet G2 for 4 years) - $42.00 + GST
- Paediatric Electrode pad & replacement – $7.00 + GST
- Real-Time CPR Feedback (Free CPR) – $10.00 + GST
- AED Cabinet with Strobe Light & Alarm – $8.50 + GST
- AED Waterproof Cabinet- $14.00 + GST
Rental & Fees—Please note a $150 Ex. GST document fee is applicable for every deal. Term: 48 months
If you have any queries please call (03) 9429 2666 or mail at admin@cardiacdefibrillators.com.au.
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