Application Form

It takes less than 3 minutes

Loan Details
How much cash do you need?
How much cash do you need?
Paid back over approx
Paid back over approx
How often can you make these repayments?*
Date of your first repayment*
Region*
Is there a joint borrower?*
Guarantors
Regretfully due to the additional identification and disclosure requirements for Guarantors, any loan using a Guarantor must be hard copy printed. Government legislation requires that the Guarantor signs the Loan Contract in front of a Lawyer. We’re sorry we can’t offer electronic signing for loans involving Guarantors, however if you think this will be an issue, please call us on 0800 784 252.
Security
All of our loans need a vehicle, real estate or boat for security. The value of the security needs to be greater than the amount you borrow and if you're using a vehicle it needs to have a current WOF and registration
What can you use for security on the loan*
All of our loans require a vehicle, boat or real estate for security. We can't use household chattels.
If you don’t have something to offer yourself you could look at using a Guarantor or joint borrower who can offer security to support your application. Give us a call on 0800 784 252 to discuss your options.
Please note: we can only accept motor vehicles from 2000 onwards for security purposes
Vehicle registration plate #*
Make*
Model*
Year*
Is there money owed on the vehicle?*
PLEASE NOTE: THE VALUE OF THE SECURITY (NET OF OUTSTANDING DEBT), MUST BE GREATER THAN THE AMOUNT YOU WISH TO BORROW. ALL VEHICLES USED AS SECURITY MUST ALSO HAVE A CURRENT WOF AND REGO.
How much is owing?*
How much is owing on your vehicle?
Secondary Vehicle registration plate #*
Secondary Vehicle Make*
Secondary Vehicle Model*
Secondary Vehicle Year*
Is there money owed on the secondary vehicle?*
ALL OF OUR LOANS NEED A DEBT FREE VEHICLE, REAL ESTATE OR BOAT FOR SECURITY. THE VALUE OF THE SECURITY NEEDS TO BE GREATER THAN THE AMOUNT YOU BORROW AND IF YOU'RE USING A VEHICLE IT NEEDS TO HAVE A CURRENT WOF AND REGISTRATION
How much is owing on your vehicle?
Real estate address*
Approximate mortgage balance*
Personal Details
Contact Details
Income/Expenses
Bank Details
$2000 today, repayed at $50.00 per week

Please phone for a custom rate on loans over $10,000

Loan Details
Personal Details
Please complete your first, middle and last name and date of birth exactly as they appear on your Licence, Passport or other ID.
Title*
First Name*
Middle Name
Surname*
Date of birth (dd/mm/yyyy)*
Gender*
Occupation*
Employer*
Employment status*
Length of employment*
How many dependants do you support?*
Identification
Are you a New Zealand resident*
Type of photo ID*
Driver licence number (5a)*
Version number (5b)*
Passport number*
Passport Issue date*
Passport expiry date*
Firearms licence*
* We will require a copy of this ID (scanned or photo from your phone) to be emailed to apply@qcf.co.nz
Joint Applicant - Personal Details
Joint Applicant's title*
Joint Applicant’s first name*
Joint Applicant’s middle name*
Joint Applicant’s surname*
Joint Applicant’s date of birth (dd/mm/yyyy)*
Joint Applicant’s marital status*
Joint Applicant’s gender*
Joint Applicant’s occupation*
Joint Applicant’s employer*
Joint Applicant’s employment status*
Joint Applicant’s length of employment*
How many dependants does the Joint Applicant support?*
Joint Applicant’s street number and name*
Joint Applicant’s suburb*
Joint Applicant’s city/region*
Joint Applicant's postcode*
Joint Applicant's time at address:*
Joint Applicant’s residence type*
Joint Applicant’s mobile phone number*
Joint Applicant’s mobile phone number*
Joint Applicant’s mobile phone number*
Joint Applicant’s email address*
Joint Applicant’s home phone number (landline)
Joint Applicant’s home phone number (landline)
Joint Applicant’s home phone number (landline)
Joint Applicant’s work phone number (landline)
Joint Applicant’s work phone number (landline)
Joint Applicant’s work phone number (landline)
Joint Applicant - Identification
Is the Joint Applicant a New Zealand citizen*
Joint Applicant’s type of photo ID*
Joint Applicant’s driver licence number (5a)*
Joint Applicant’s version number (5b)*
Joint Applicant’s passport number*
Joint Applicant's passport issue date*
Joint Applicant's passport expiry date*
Joint Applicant’s firearms licence*
* We will require a copy of this ID (scanned or photo from your phone) to be emailed to apply@qcf.co.nz
Guarantor - Personal Details
Guarantor’s title*
Guarantor’s first name*
Guarantor’s middle name*
Guarantor’s surname*
Guarantor’s date of birth (dd/mm/yyyy)*
Guarantor’s gender*
Guarantor’s marital status*
Guarantor’s occupation*
Guarantor’s employer*
Guarantor’s employment status*
Guarantor’s length of employment*
How many dependants does the guarantor support?*
Guarantor’s street number and name*
Guarantor’s suburb*
Guarantor’s city/region*
Guarantor's postcode*
Guarantor’s time at address:*
Guarantor’s residence type*
Guarantor’s mobile phone number*
Guarantor’s mobile phone number*
Guarantor’s mobile phone number*
Guarantor’s email address*
Guarantor’s home phone number (landline)
Guarantor’s home phone number (landline)
Guarantor’s home phone number (landline)
Guarantor’s work phone number (landline)
Guarantor’s work phone number (landline)
Guarantor’s work phone number (landline)
Guarantor - Identification
Is the guarantor a New Zealand citizen*
Guarantor’s type of photo ID*
Guarantor’s driver licence number (5a)*
Guarantor’s version number (5b)*
Guarantor’s passport number*
Guarantor’s passport expiry date*
Guarantor’s firearms licence*
* We will require a copy of this ID (scanned or photo from your phone) to be emailed to apply@qcf.co.nz
Joint Applicants and Guarantors must be New Zealand Citizens
Contact Details
Income/Expenses
Bank Details
$2000 today, repayed at $50.00 per week

Please phone for a custom rate on loans over $10,000

Loan Details
Personal Details
Contact Details
This section relates to the Main Applicant
Street number and name*
Suburb*
City/Region*
Postcode*
Time at address:*
Residence type*
Mobile phone number*
Mobile phone number*
Mobile phone number*
Email address*
Home phone number (optional)
Home phone number (landline)
Home phone number (landline)
Work phone number (optional)
Work phone number (landline)
Work phone number (landline)
Income/Expenses
Bank Details
$2000 today, repayed at $50.00 per week

Please phone for a custom rate on loans over $10,000

Loan Details
Personal Details
Contact Details
Income/Expenses
Applicant’s Income
We need you to complete this section accurately to ensure we can make a responsible lending decision.
Source of Income

Amount

Frequency

Received From
Main applicant take home pay*
Frequency*
Received from*
Partner's take home pay
Frequency
Received from
Other income (boarder, assistance etc)
Frequency
Received from
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Income for Joint Applicant/Guarantor
Source of Income

Amount

Frequency

Received From
Joint applicant/Guarantor take home pay*
Frequency*
Received from*
Partner's take home pay
Frequency
Received from
Other income (boarder, assistance etc)
Frequency
Received from
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Applicant’s Expenses
Expense Type

Amount

Frequency

Paid To
Rent/Mortgage/Board
Expense Duration
Expense Paid To
Regular fix expenses ( eg: SKY TV, Fines etc.)
Expense Duration
Expense Paid To
Loans/Credit cards/HP’s
Expense Duration
Expense Paid To
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Joint Applicant/Guarantor Expenses
Expense Type

Amount

Frequency

Paid To
Rent/Mortgage/Board
Expense Duration
Expense Paid To
Regular fix expenses ( eg: SKY TV, Fines etc.)
Expense Duration
Expense Paid To
Loans/Credit cards/HP’s
Expense Duration
Expense Paid To
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Bank Details
$2000 today, repayed at $50.00 per week

Please phone for a custom rate on loans over $10,000

Loan Details
Personal Details
Contact Details
Income/Expenses
Bank Details
Bank information
This is the account we will put your cash into. It must be the same one your income goes into and automatic payments will come out of.
Bank account number*
1st Block 2nd Block 3rd Block 4th Block
Full name on the account*
Other Information
Do you want to insure yourself in case of changes to your payment ability?*
You can find all the info about PPI by clicking here
Having PPI provides peace of mind during your loan, and can be included in your repayments. Click here to see the benefits
Reason For Loan*
Emergency contact person not living with you*
Phone number of emergency contact*
Phone number of emergency contact*
Phone number of emergency contact*
What is your credit rating like?*
Additional Comments
$2000 today, repayed at $50.00 per week

Please phone for a custom rate on loans over $10,000
Terms and conditions*
- I/we as the main applicant, joint applicant and/or guarantor have read and understood the terms and conditions of this application.
We're sorry but we're unable to approve your loan without security. All of our loans need a freehold vehicle, boat or real estate to support them. You may be able to add a Guarantor to your loan if they have a vehicle they're willing to use as security. Give us a call on 0800 784 252 if you have any questions.
Name
This field is for validation purposes and should be left unchanged.

Application Form

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