Skip to content
1300 12 11 10
leasing@selfco.com.au
Suite 106, Macarthur Point, 25 Solent Circuit, Baulkham Hills NSW 2153
Facebook
Twitter
Linkedin
Skype
YouTube
Selfco Leasing
Financing solutions for Australian small businesses
About Us
Our People
Brokers
FAQ
Contact Us
About Us
Our People
Brokers
FAQ
Contact Us
Submit An Application
Step 1 of 4 - Broker Details
25%
Broker Company
Broker Contact
Email
*
Phone
*
Borrower Details
Borrowing Entity
Sole Trader
Partnership
Company
Trust
Borrower
Trust
Trading Name
ABN
Nature of Business
Trading Address
Guarantor Details - Director #1
Surname
Other Names
Drivers Licence
Exp
Card
DOB
Home Phone
Work Phone
Mobile Phone
Email
Residential Status
Own
Buying
Renting
Boarding
Residential Address
Landlord Details
Director #2
Surname
Other Names
Drivers Licence
Exp
Card
DOB
Home Phone
Work Phone
Mobile Phone
Email
Residential Status
Own
Buying
Renting
Boarding
Residential Address
Landlord Details
Attachments
Privacy Consent
Drop files here or
Accepted file types: jpg, jpeg, gif, png, bmp, tif, psd, pdf, doc, docx, xls, xlsx, txt, zip, gz, rar, z, sitx.
Broker Submission
Drop files here or
Accepted file types: jpg, jpeg, gif, png, bmp, tif, psd, pdf, doc, docx, xls, xlsx, txt, zip, gz, rar, z, sitx.
Quote / Invoice
Drop files here or
Accepted file types: jpg, jpeg, gif, png, bmp, tif, psd, pdf, doc, docx, xls, xlsx, txt, zip, gz, rar, z, sitx.
Drivers Licence
Drop files here or
Accepted file types: jpg, jpeg, gif, png, bmp, tif, psd, pdf, doc, docx, xls, xlsx, txt, zip, gz, rar, z, sitx.
Assets & Liabilities Statement
Drop files here or
Accepted file types: jpg, jpeg, gif, png, bmp, tif, psd, pdf, doc, docx, xls, xlsx, txt, zip, gz, rar, z, sitx.
Financials
Drop files here or
Accepted file types: jpg, jpeg, gif, png, bmp, tif, psd, pdf, doc, docx, xls, xlsx, txt, zip, gz, rar, z, sitx.
Other
Drop files here or
Accepted file types: jpg, jpeg, gif, png, bmp, tif, psd, pdf, doc, docx, xls, xlsx, txt, zip, gz, rar, z, sitx.
Finance Reference
Name of Lender
Financed Amount
Repayment
Date taken out
Transaction Details
Program
Lite Doc
No Doc
Full Doc
Equity Funding
Product
Chattel Mortgage
CHP
Lease
Rental
Cost (inc GST)
Term
Brokerage
Other
Deposit
Amount Financed
Residual / Balloon
Goods Description
Goods
Please select...
New
Used
Year
Make
Model
Description
Supplier
Contact
Phone
Phone
This field is for validation purposes and should be left unchanged.
This iframe contains the logic required to handle AJAX powered Gravity Forms.
Go to Top
