Client Information Form

Welcome to our Financial Snapshot
In order for us to provide you with high quality credit advice please complete our secure client information form. All data is encrypted and only authorised staff will have access to your supplied information.

How long will this take?

About 5-10 minutes. Try to be accurate but it does not need to be absolutely exact to the last dollar.

Save your form

You can save your form if you'd like to come back to it later. Just click the Save button found at the bottom of each section.

A quick tip if using this form on an iPhone or iPad

Do not click the 'go' button as it will take you to the next page - just click the 'X' button after typing. It will then let you go to the next question or field.

If you have any questions please contact us on 0403 359 803 or by email at info@xcelleratefinance.com.au

Many thanks,

The team at Xcellerate Finance & Mark Rolton Property
Date*

DayMonthYear
Date
Brokerage name
Brokerage email
example@example.com
Have you been referred to a specific broker within our team?*
Loan purpose*
No. of applicants*
Property value/price*
Est. loan amount $
YesNo
What type of property does this application relate to?*
e.g. Apartment, townhouse, house, vacant land, etc.
EstablishedTo be builtNewly built/off-plan

Rows	Value
Cash savings
Personal effects / home contents
Superannuation
Shares
Other investments
Other assets

Loans other than home and vehicle

(include ALL debts even if you don't think they are important or they are part of your business)

Store and credit cards

(include ALL cards even if you don't use them and/or they have zero balance)

CREDIT GUIDE & PRIVACY DISCLOSURE CONSENT
Yes, I/we appoint the Broker or Connective to obtain a credit report on my/our behalf
Applicant 1*

First NameLast Name
Date*

DayMonthYear
Date
Applicant 1 email
example@example.com
Applicant 1 mobile
Applicant 1 signature*
Applicant 2*

First NameLast Name
Date*

DayMonthYear
Date
Applicant 2 email
example@example.com
Applicant 2 mobile
Applicant 2 signature*
Consent to receive marketing Information - you consent to us doing so & we may provide you with information from time to time about new products and services available to you from us or other businesses with whom we have a relationship. Your consent to our providing this information to you will be implied unless you notify us that you do not wish to receive this information.
I/we do not wish to receive marketing information
Consent to receive documents electronically - you consent to us providing you with documents by electronic communication, you confirm that paper documents may no longer be given, and electronic communications must be regularly checked for documents. Consent to the giving of documents by electronic communication may be withdrawn at any time.
I/we do not wish to receive documents electronically
Please be patient, it can take up to a minute to send us all of your information. Once complete, this page will refresh to our needs analysis questionnaire.
Should be Empty: