BLACKBIRD FINANCE LIMITED & BLACKBIRD AUTOS LIMITED
DEALER CREDIT APPLICATION
PRIVATE & CONFIDENTIAL
COMPANY / BUSINESS ENTITY
Registered Name of Entity:
Trading Name:
GST No:
Registered Trader Number:
Company/Entity No:
Began Trading:
Nature of Business:
No. of employees:
Address: (street)
Address: (postal)
(
Phone No:
)
Fax No:
Contact Person:
Phone No:
(
)
Position:
(
)
Mobile No:
(
)
Email:
PRINCIPAL DIRECTORS / SHAREHOLDERS
Names of principal Directors / Shareholders
Designation - Director / Shareholder
% of shareholding
BUSINESS ACCOUNTANT
Name:
Contact Person:
Address:
Phone No:
(
)
Fax No:
(
)
BANK DETAILS
Bank:
Address:
Account Name:
Bank
Branch
Account Number
Suffix
INSURANCE DETAILS
Insurance Co /Broker:
Postal Address:
DETAILS OF BUSINESS
Describe company structure and history of business: _______________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________ _____________________
Identify any associated Companies / Trusts / Partnerships / Individuals: ______________________________________________________________________________
_____________________________________________________________________________________________________________________________ _____________________
Years in Motor Vehicle business: ___________
Years in Business:
__________
Cars sold / month: __________
Are you a retailer or wholesaler: __________________________________
Average dealer stock units:__________
Average days to sell:__________
Are your business premises: Owned freehold / Mortgaged / Leased
Do you share your site(s) with anyone else:
Yes / No
If Yes, describe arrangements: ______________________________________________________________________________________________ _______________________
TRADE REFEREES
Name:______________________________________
Address:________________________________________________
Phone:______________________
Name:______________________________________
Address:________________________________________________
Phone:______________________
Name:______________________________________
Address:________________________________________________
Phone:______________________
CURRENT FINANCE & SECURITY
Current Floor Plan Provider:_______________________________________
Facility Held for:_________years
Current Outstanding: $______________________
Monthly Payments: $____________________
Facility Credit Limit: $________________
Detail security for current facility:___________________________________________________________________________________________________________________
FACILITY REQUESTED
PLEASE TICK TO SELECT THE TYPE OF FACILITY YOU ARE APPLYING FOR:
OPTION 1. Blackbird Express Facility, Approval may be granted for a facility limit of up to NZ$50,000, without the provision of further financial information:
OPTION 2. Blackbird Standard Facility, Approval subject to provision of financials as per below, Facility Limit Applied For: NZ$______________________
Funding Requested for vehicles purchased from:
Japan
United Kingdom
(tick either one or both)
++
ACKNOWLEDGEMENTS
I/We acknowledge that any representations made concerning the application have been made to Blackbird Finance Limited (“BBF”) and Blackbird
Autos Limited (“BBA”) to enable BBF and BBA to determine whether to grant finance, and if granted, for credit, service and general marketing
purposes.
To facilitate the above purposes, I hereby authorise BBF and BBA to make any enquiries relative to the statements given in the application, which they
considers necessary or expedient and to obtain any additional information including details of financial affairs. I hereby irrevocably request and
authorise any person or company to supply such information to BBF and BBA or their financiers or assigns from time to time.
The credit applied for is of the type requested by the applicant, and for the purposes of the Consumer Guarantees Act 1993 the application for the
supply of credit is for the purposes of a business. Accordingly, under the agreement/s that may result from this application, the Act is excluded.
The information provided in this application is true, correct and complete, and no information that would be relevant to BBF or BBA in evaluating the
application has been omitted. If any relevant changes occur between now and the signing of a credit agreement with BBF and/or BBA, disclosure of
such changes will be made to BBF and BBA immediately.
Director’s Name:
Director’s Name:
Signature:
Signature:
Date
SUPPORTING INFORMATION TO BE PROVIDED
Some or all of the following information will be required in order to consider your application:

Signed Blackbird Finance Statement of Positions for all business principals, directors, guarantors

Photocopies of photo IDs for all business principals, directors, guarantors (Drivers Licence or Passport)
ADDITIONAL INFORMATION REQUIRED FOR OPTION 2 ONLY, WHERE PROPOSED FACILITY LIMIT EXCEEDS NZ$50,000

Annual Financial Accounts for the last 2 years

Management Accounts since last balance date

Business bank statements for the last 2 months

Confirmation of current comprehensive insurance policy covering Dealers vehicle stock
2
BLACKBIRD FINANCE LIMITED & BLACKBIRD AUTOS LIMITED
STATEMENT OF POSITION (Dealer Finance)
Business Principal, Director, Guarantor
PRIVATE &
CONFIDENTIAL
PERSONAL INFORMATION
Full Name:
Address:
Phone Number: (
)
Mobile:
Email:
Date of Birth:
Have you ever been adjudged bankrupt:
Yes / No
If Yes, when: _____________
Have you been discharged:
Yes / No
Are you a trustee or beneficiary of any Trust(s):
Yes / No
If yes, list the name(s) of the Trust(s):____________________________________________
_____________________________________________________________________________________________________________________________ __________________
FINANCIAL INFORMATION (Net Monthly Figures Only)
INCOME (Monthly)
Monthly net income
ASSETS
$
Property/Home
$
Other Income (please specify)
Cash/Bank
$
…………………………………………
Vehicle/s
$
$
………………………………………...
$
Home Contents
TOTAL ( A )
$
Investments (please specify)
………………………………..…………...
EXPENSES (Monthly)
$
Other (please specify)
Mortgage/Rent payments
$
………………………………..…………...
$
HP, loans, credit accounts
$
TOTAL ( C )
$
Rates, phone, power, car expenses
$
Insurance
$
LIABILITIES
Living expenses
$
Mortgage
$
Credit Cards, Other
$
Credit Cards
$
TOTAL ( B )
$
HP/Credit Accounts
$
NET SURPLUS per month
(A)–(B)
$
Bank Overdraft/Loan
$
Other Creditors, loans (please specify)
………………………………..…………...
$
TOTAL ( D )
$
NET WORTH ( C ) – ( D )
$
ACKNOWLEDGEMENTS
1.
2.
3.
I understand that:
1.1 I may contact Blackbird Finance Limited (“BBF”) and/ or Blackbird Autos Limited (“BBA”) to request access to and correction of any
information about me that you hold and you will supply to me on request the names and addresses of any agencies to whom you have
disclosed information about me.
I authorise you to:
2.1 make all such enquiries about me and my financial affairs as you consider appropriate in relation to my request for credit from BBF and/or
BBA, and to disclose details of this statement of position to any person for this purpose. I authorise any party approached by you to disclose
such information to you; and
2.2 disclose details of this statement of position to any credit agency, debt collector or solicitor.
I certify that:
3.1 the information provided in this statement of position is true, correct and complete, and no information that would be relevant to you in
evaluating the statement of position has been omitted. If any relevant changes occur between now and signing any agreement with you, I
will disclose such changes to you immediately.
The information in this statement of position is being collected, and will be held by, Blackbird Finance Limited and Blackbird Autos Limited.
Signature
Date