Surname* First Name*

Mobile* Home Phone*

Date of Birth* Driver's Licence No.*

Email*

Street*

Suburub* State* Postcode*

Business Name* ABN*

Your Title* (Person authorised to sign agreement on behalf of the business)

How long have you owned and operated the above business* (Years/Months)

Residential Status* I rent a House/Unit I own a House/Unit I am buying a House/Unit I live with my parents

If zero, please type '0' at each item below

In accordance with the Privacy Act 1988 (Cth) provided on the web site (www.ezyrentalequipment.com.au/privacy-policy), the Applicant/Renter acknowledges and agrees that EZY Rental Aus Pty Ltd (owner) may give to and seek from financial institutions, credit reporting agencies, or any personal credit and/or consumer credit information providers (“the Sources”) information in relation to the Renter’s personal and/or commercial creditworthiness. The Renter authorises the Owner to obtain from the Sources, and authorises the Sources to provide, a credit report containing personal information in relation to the Renter and/or any information concerning the personal and/or commercial creditworthiness or commercial activities of the Renter including, but not limited to, credit standing, credit history, credit capacity or any other information which may be provided under the Privacy Act 1988 (Cth). The Renter authorises the Owner to disclose any information in its possession concerning the Renter’s commercial creditworthiness or commercial activities to the Sources.

I/We hereby declare that the above particulars are true and correct. I am /We are over the age of 18 and that I am /We are not an undischarged bankrupt. I/We hereby authorise you to make any enquiries relating to the persons herein named or otherwise.

Acceptance by Applicant or authorised director/person/proprietor

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Company Name* ACN*

ABN of Trust

Trading Name* ABN*

Contact*

Email*

Mobile* Home Phone*

Street*

Suburb* State* Postcode*

How long has the company been operating* (Years/Months)

Director 1

Full name Residential Status I rent a House/Unit I own a House/Unit I am buying a House/Unit I live with my parents

Street*

Suburb* State* Postcode*

Date of Birth Driver's Licence No.

Email

Director 2

Full name Residential Status I rent a House/Unit I own a House/Unit I am buying a House/Unit I live with my parents

Street*

Suburb* State* Postcode*

Date of Birth Driver's Licence No.

Email

Director 3

Full name Residential Status I rent a House/Unit I own a House/Unit I am buying a House/Unit I live with my parents

Street*
Suburb* State* Postcode*

Date of Birth Driver's Licence No.

Email

In accordance with the Privacy Act 1988 (Cth) provided on the web site (www.ezyrentalequipment.com.au/privacy-policy), the Applicant/Renter acknowledges and agrees that EZY Rental Aus Pty Ltd (owner) may give to and seek from financial institutions, credit reporting agencies, or any personal credit and/or consumer credit information providers (“the Sources”) information in relation to the Renter’s personal and/or commercial creditworthiness. The Renter authorises the Owner to obtain from the Sources, and authorises the Sources to provide, a credit report containing personal information in relation to the Renter and/or any information concerning the personal and/or commercial creditworthiness or commercial activities of the Renter including, but not limited to, credit standing, credit history, credit capacity or any other information which may be provided under the Privacy Act 1988 (Cth). The Renter authorises the Owner to disclose any information in its possession concerning the Renter’s commercial creditworthiness or commercial activities to the Sources.

I am / We are duly authorised to provide the information on behalf of the Company and to make this application on behalf of the Company I / We hereby declare that the above particulars are true and correct. I / We warrant that the company is currently solvent. I / We hereby authorise you to make any enquiries relating to the company and any person herein named or otherwise.

Acceptance by Applicant or authorised director/person/proprietor

Please verify that you're not a robot by answering this question: 13 + 7 =