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Online Application Form


You can start your application on line by completing this secure application form. On receipt we will process your application and contact you to confirm the products you desire. The application is on a secure site, your information will only be used for the purpose of the application and will also be shared with the credit process provider.

Personal Information

Middle Name
Surname *
Date of Birth *

Residential Information

If less than 12 months previous address


Employment Information

Yes No
Yes No

Credit Information



3 references are required, one relative and two friends

Reference 1


Reference 2


Reference 3


Rental Program Required

Short Term Rental Rent To Own

Select products from the following table

Fridges Washing Machines Televisions
Small Fridge 205 to 240L
Medium Fridge 280 to 330L
Large Fridge 360 to 390L
Extra Large Fridge 440 to 520L
4kg Small Compact Washer
4.5kg Small Washer
5 - 6.5kg Medium Washer
Large 7.5Kg plus
Front Loader Washer
LCD 66cm
LCD 101-106cm
LCD 140cm
Plasma 106cm
68cm Flat Screen
81cm Flat Screen
51cm Flat Screen
TV Stand
HD Set top box
Dryers Freezers Computer
3.5kg Small Dryer
4.0kg Medium Dryer
5.0kg Large Dryer

Entertainment Other Products Furniture

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