Tech Connect Loan Enquiry Form
Head Tenant / Borrowers Details
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Post Code
Date of Birth
*
-
Day
-
Month
Year
Date
Age
Gender
*
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: 0000 000 000.
Eligibility Criteria Note: All criteria must be met to be eligible for a Tech Connect Loan
*
I have been a Pacific Link tenant or household member for more than 6 months
I am an Australian citizen or permanent resident
My rent payments and non-rent payments are up to date
Are you of Aboriginal or Torres Strait Islander origin?
Aboriginal
Torres Strait Islander
Neither
Do you speak a language other than English at home?
Yes
No
If Yes please specify
Do you have a disability or ongoing medical condition?
Yes
No
Prefer not to say
Comments
What item(s) would you like a Tech Connect Loan for? Note: multiple items can be selected as long as the total loan amount is less than $1,000.
*
Laptop
Tablet
Smart Phone
Other
Please specify
Please upload any invoices or quotes for specific items or model if relevant.
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What is the main reason you would like the laptop or device for?
*
Studies/Education
Learn new skills
Keep connected with friends/family
Replace/update outdated equipment
Other
Please specify
What is your preference for the loan term?
*
12 Months
18 Months
Please upload two forms of identification.
*
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Do you give consent for PLH to use your photograph for publicity purposes?
Yes
No
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