HSA Finance Business Credit Application Form
Return your completed and signed application form together with the supporting documentation as requested.
Tell us about your business.
Full legal entity name of borrower (including trust if applicable):
*
ABN or ACN
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date moved in
*
-
Month
-
Day
Year
Date
Business Background (please include as much detail as possible)
*
What are the Business Activities (please include as much detail as possible)
*
When was the business established & what previous experience do all director/shareholders have? (please include as much detail as possible)
*
Tell us what you need.
How much would you like to borrow?
*
What will the borrowed funds be for?
*
Property Related
Business Growth
Business Expenses
Restructure/Consolidate
Equipment or Vehicle Finance
Other
Purpose of funds, detail what funds are required for:
*
Related Entities
Are you a director or shareholder for any other Australian Trading Companies? If yes, please answer questions below.
*
Yes
No
Full legal entity name of borrower (including trust if applicable):
*
ABN or ACN
Copy of Trust Deed - If applicable
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Tell us about yourself
Personal Details to be included for each individual borrower, guarantor & representative (e.g. company director or officer) of the borrower and/or trading entity.
Applicant 1
Any director, shareholder or guarantor:
Full Name
*
First Name
Last Name
Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Residential Status
*
Owner/Mortgage
Renting
Live with Parents
Boarding
Other
Date moved in
*
-
Month
-
Day
Year
Date
Date of Birth
*
-
Month
-
Day
Year
Date
Mobile
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Marital Status
*
Number of Dependents
*
Copy of the Front & Back of your Drivers Licence.
*
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Signature
*
Applicant 2
Any director, shareholder or guarantor:
Full Name
First Name
Last Name
Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Residential Status
Owner/Mortgage
Renting
Live with Parents
Boarding
Other
Date moved in
-
Month
-
Day
Year
Date
Date of Birth
-
Month
-
Day
Year
Date
Drivers Licence Number
State of Issue
Mobile
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Marital Status
Number of Dependents
Copy of the Front & Back of your Drivers Licence.
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Signature
Applicant 3
Any director, shareholder or guarantor:
Full Name
First Name
Last Name
Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Residential Status
Owner/Mortgage
Renting
Live with Parents
Boarding
Other
Date moved in
-
Month
-
Day
Year
Date
Date of Birth
-
Month
-
Day
Year
Date
Drivers Licence Number
State of Issue
Mobile
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Marital Status
Number of Dependents
Copy of the Front & Back of your Drivers Licence.
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Signature
Applicant 4
Any director, shareholder or guarantor:
Full Name
First Name
Last Name
Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Residential Status
Owner/Mortgage
Renting
Live with Parents
Boarding
Other
Date moved in
-
Month
-
Day
Year
Date
Date of Birth
-
Month
-
Day
Year
Date
Drivers Licence Number
State of Issue
Mobile
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Marital Status
Number of Dependents
Copy of the Front & Back of your Drivers Licence.
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Signature
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Acknowledgements you make in completing this application
In completing this application, I/we confirm the following:
The borrower, the trading entity and I/us do not have any overdue liabilities for taxes or statutory payments.*(e.g. GST, Group Tax, Superannuation, etc)
*
Yes
No
If no, please detail the outstanding liabilities.*
There is no legal action pending or in progress in relation to the borrower, the trading entity or me/us which may affect thebusiness* (e.g. creditor action, administrator/liquidator appointment etc.)
*
Yes
No
If no, please briefly explain the legal action pending or in progress.*
I/we/the borrower have the capacity to repay all current credit obligations in addition to the proposed obligations as documented in this application.*
*
Yes
No
In both the near term and the longer term, there are no likely changes to the future financial circumstances of the borrower, the trading entity or me/us that could impact the borrower, the trading entity and/or my/our ability to repay the facilitiessought.*
*
Yes
No
If no, please explain the nature of the changes**
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Privacy and Confidentiality Statement
Collection and use of your personal information, please read and agree below:
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Supporting Documents
Please provide what you can, or email direct.
FY22 Company Financials & Tax Returns
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FY23 Company Financials & Tax Returns
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2022 Individual Tax Return, all directors/shareholders & Guarantors
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2023 Individual Tax Return, all directors/shareholders & Guarantors
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2022 & 2023 Notice of Assessments
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PAYG Pay slips if applicable
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YTD Financials and/or Cash Flow Forecast
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Business Plan (New purchase or Start up)
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Submit
Submit
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