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Apply Now - Or Call 1300 789 783

Express Audit Form Part 1
Between: Clear Credit Solutions (Provider) and
Client *
Address *
PLEASE ANSWER ALL QUESTIONS AND TICK CORRECT RESPONSES
Surname *
Middle Name
First Name *
Have you used a credit repair agency before *
 Yes No
If yes, name of Institution
How did you find us *
Email *
Have you ever used another name *
 Yes No
Any other surname you have used
Any other first name used
Sex *
 Male Female
Date of Birth *
Do you currently hold a drivers licence *
 Yes No
Current drivers licence number
Previous drivers licence number
Daytime Contact Number
Home
Work
Mobile *
Name of previous employer
Employment
Are you currently employed *
 Yes No
Name of current employer
Self Employed
Business Name
Name of the company who you last applied for credit e.g. Name of bank or credit union
Address
Current residential address *
Previous residential address*
Additional previous address
Are you currently bankrupt or in a Part debt agreement *
 Yes No
Court Judgements/Black Marks

Please list defaults/court judgements on your credit file: (If you are unaware of these listings an estimate is fine)

Amount
Company
Amount
Company
Amount
Company
Amount
Company
Please enter your full name
Signed by Client *
Date *
By signing you are agree to the terms and conditions, your on line signature is the same as your original signature and is binding to this contract.

Apply Now - Or Call 1300 789 783

Express Audit Form Part 1
Between: Clear Credit Solutions (Provider) and
Client *
Address *
PLEASE ANSWER ALL QUESTIONS AND TICK CORRECT RESPONSES
Surname *
Middle Name
First Name *
Have you used a credit repair agency before *
 Yes No
If yes, name of Institution
How did you find us *
Email *
Have you ever used another name *
 Yes No
Any other surname you have used
Any other first name used
Sex *
 Male Female
Date of Birth *
Do you currently hold a drivers licence *
 Yes No
Current drivers licence number
Previous drivers licence number
Daytime Contact Number
Home
Work
Mobile *
Name of previous employer
Employment
Are you currently employed *
 Yes No
Name of current employer
Self Employed
Business Name
Name of the company who you last applied for credit e.g. Name of bank or credit union
Address
Current residential address *
Previous residential address*
Additional previous address
Are you currently bankrupt or in a Part debt agreement *
 Yes No
Court Judgements/Black Marks

Please list defaults/court judgements on your credit file: (If you are unaware of these listings an estimate is fine)

Amount
Company
Amount
Company
Amount
Company
Amount
Company
Please enter your full name
Signed by Client *
Date *
By signing you are agree to the terms and conditions, your on line signature is the same as your original signature and is binding to this contract.