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Do not apply if you are a Centrelink recipient, unemployed or self- employed

Surname *

Given Name *

Gender *

Date of Birth *

Address

Address Line 1

City

State / Province / Region

Postal Code

Phone *

Email *

Driver's License Number *

Medicare Card Number *

Employer Name *

Employer Phone *

Net income/Month *

Bank Name *

BSB *

Account No *

Loan amount required *

Existing Outstanding Loans:

Total Amount *

Number of Outstanding Repayments

Specific Repayment Amounts and Dates:

Date

Amount to be repaid

Date

Amount to be repaid

Date

Amount to be repaid

Date

Amount to be repaid

Do you see anything in your foreseeable future that may affect your ability to repay this contract. (Ie - The arrival of a new baby, an addiction such as gambling, a current employment contract finishing, etc.) *

I confirm that I will use the loan for *

Electronic Signature *

Clear Signature

Date *

Checkboxes *

I confirm that I read and understood the Credit Guide May 2022. Terms & Conditions of Credit Contract

Tilmak Pty Ltd trading as The Money Centre Melbourne City, ABN 74054353954, Australian Credit License 395052

For our Small Loans of $2,000 or less, an APR (Annual Percentage Rate) doesn't apply. These loans are fee-based only with a term between 62 and 180 days, and so the APR is 0%. The establishment fee is 20% of the amount borrowed and the monthly fee is 4% of the amount borrowed. Representative example: a loan of $1,000 repaid over 3 months equates to a total amount payable of $1,320 comprised of $1,000 principal (amount borrowed), $200 establishment fee and $120 in monthly fees. The maximum comparison rate on loans between $300 and $2000 is 199.43%.

Warning About Borrowing

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Tilmak Pty Ltd trading as The Money Centre Melbourne City, ABN 74054353954, Australian Credit License 395052

The Money Centre Melbourne City Centre

The Money Centre Melbourne City holds Australian Credit License Number 395052