New Client Referral Form

*Please ensure your computer does not auto fill this form. Please complete it field by field – thanks.

    What is the Referrer/Coach's name? (please use first & surname)

    What is the Referrer/Coach's email?

    Additional email you'd like notifications to be sent to here.

    What is your client's first name? *please use first name as per ID, no nicknames please

    What is your client's last name?

    What is your client's email address? *please use same email that will be used for appointment booking in next step

    What is your client's phone number?

    What is the name of the product they're purchasing from you?

    What is the amount of money required in Australian Dollars? Please include GST is applicable.
    *Please note: Your client MUST be an Australian Resident.

    What is their employment status? Eg. Full Time, Part Time, Casual, Self-Emp or Gov benefits and how long have you been at that job?
    *please note: if they're on maternity/paternity leave, we cannot use their income until they are back at work and have one payslip.

    If they're Self Employed: What is their average monthly income & how long have you had your business?

    For Employee's: How much income are they making per week/month?

    Do you have any credit defaults that you know of?

    Have you had financial hardship on any loans or credit cards in the last 3 months?
    *If Yes - please talk to your client about an in house payment plan as we can’t finance someone if they’ve had hardship on a loan/credit in the last 3 months.

    Have you been bankrupt or had a part 9 debt agreement in the last 5 years?
    *If Yes - please talk to your client about an in house payment plan as we can’t finance someone if they’ve had either of these in the last 5 year, even if they are now discharged

    Who is your Lifestyle Finance Aus Finance Specialist?
    *If you usually select Jane, please know Ram is your Permanent Finance Specialist now. Book calls with Ram

    Is there anything else we need to be aware of that might affect your chances of this going though?

    Have you informed the applicant to check their email and send documents before their application call?

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