Forlongs Individual Account Application

Your Details

First Name *

Middle Name

Last Name *

Date of Birth *

Please Attach Drivers Licence or Passport *
Please attach a photo of your Drivers License or Photo page of your Passport

Current Residential Details

Unit/Flat

Street Number *

Street Name *

Suburb

City *

Time at Current Residential Address *

Landline Phone

Mobile Phone

Preferred Contact Phone *

Email Address *

Please Attach Proof of Address
Please attach a copy of your power bill, rates invoice, payslip or bank statement. If you are unable to upload a copy, please email this through to [email protected]

Current Postal Details:

Same as Above? *

Yes

No

Unit/Flat

Street Number *

Street Name *

Suburb

City *

Renters & Boarders

Are You Renting or Boarding? *

Yes

No

Agent/Landlord's Name *

Agent/Landlord's Phone *

$ Rent Payments *

Payment Frequency *

Weekly

Fortnightly

Monthly

Residency

Are You a Permanent NZ Resident? *

Yes

No

Are You on a Work Permit? *

Yes

No

If You Were not Born in NZ, How Long Have You Been Here? *

If on a Work Permit, When Does it Expire? *

If you are not a permanent NZ Resident please bring your passport with you when you finalise setting up your account.

Marital Status

Partner's Name *

Partner's Phone Number *

Partner's Work Place *

Partner's Occupation *

Does Your Partner Have a Forlongs Account? *

Yes

No

Current Employment Details

Current Employer *
Employer/Business Name

Contact Person *

Employer's Address *

Phone *

Occupation *

Time with Current Employer *

Please bring in Financials from Accountant when you finalise setting up your account.

Previous Employment Details

If current is less than 4 months.

Previous Employer *
Employer/Business Name

Full Name *

Employer's Address *

Phone *

Occupation *

Time with Previous Employer *

Referees

1. Nearest Living Relative in NZ

Not living at the same address as you.

First Name *

Last Name *

Current Residential Address *

Contact Phone Number *

Relationship to You
ie. Brother, Daughter, Cousin

2. Nearest Living Relative or Friend in NZ

Not living at the same address as you or the first person stated.

First Name *

Last Name *

Current Residential Address *

Contact Phone Number *

Relationship to You
ie. Brother, Daughter, Cousin

Income Details

We require this information to consider your credit risk and ability to make repayments going forward.
This information is used when considering your account credit limit.

How Often Are You Paid? *

Weekly

Fortnightly

Monthly

Please Attach Supporting Bank Statements *
Please attach a csv or pdf of your full bank statements for last 2 months.

Your Annual Income (before tax) *

Your Partners Annual Income (before tax) *

Your Assets

Do You Own a House? *

Yes

No

Do You Have a Mortgage? *

Yes

No

Which Bank Holds This Mortgage? *
IE. BNZ, ASB, TSB etc

Do You Own a Vehicle? *

Yes

No

Registration *

Do You Own a 2nd Vehicle? *

Yes

No

Model *
ie. Mazda 6

Year *
YYYY

Value *

Registration *

Your Outgoings

Do You Have a Loan From a Finance Company? *

Yes

No

What is The Name of That Company? *

$ Loan Amounts *

Repayments *
$ per week/month

Do You Have Any Other Loans From Finance Companies? *

Yes

No

What is The Name of That Company? *

$ Loan Amounts *

Repayments *
$ per week/month

Do You Have Any Other Loans From Finance Companies? *

Yes

No

What is The Name of That Company? *

$ Loan Amounts *

Repayments *
$ per week/month

Combined Credit Card limit *

Combined Current Card Balance *

Do You Have Any Outstanding Debts to Veda/Baycorp? *

Yes

No

Your Spouse/Partner or Emergency Contact Person

Full Name *

Relationship to You *
ie. Brother, Daughter, Cousin

Contact Phone Number *

Subscription Preferences

Would you like to receive your account statement via email? *
If you choose Yes your account will receive a $5 credit automatically

Yes

No

Would you like to subscribe to our promotional emails re:special offers and interest free deals *

Yes

No

Privacy Consent

The information submitted in this form will be used by the lender for the following purposes:
Assessing your credit worthiness, administering and enforcing your card account including updating and enforcing accounts and credit records with external agencies. You authorise the lender to obtain information about you from other sources as the lender reasonably requires, retain and use information about your card account and you, provide this information to related companies and agencies for the purpose above. Such information may be used in updating and maintaining credit reporting agencies files and databases, which are accessible to their customers. All such information will be held by the lender at its business address.

I apply for credit from Forlongs Furnishings Limited ("the lender"). The information contained in this application is true and correct. I am not an undischarged bankrupt. I accept the terms and conditions applying to Card use and agree to the privacy statement (opens in a new window).

Your Name *

Date *

Your Drivers Licence Number *

Your Drivers Licence Version Number