Keep Fit Hire, Rent to own application form
Questions marked by * are required.
1.
First Name: *
2.
Middle Name:
3.
Surname: *
4.
Street Address: *
5.
Suburb: *
6.
Post Code: *
7.
Email: *
8.
Home Phone:
9.
Mobile Phone:
10.
Are you working full time? (35 Hours a week or more): *
Yes
No
11.
Item Type:
-
Treadmill
Exercise Bike
Crosstrainer
Rower
Home Gym
12.
Model Number (Eg JS-4300 Treadmill)
13.
Employer Name: *
14.
Employer Street Address: *
15.
Employer Suburb: *
16.
Employer Post Code: *
17.
Employer Phone Number: (Not 1800 number etc) *
18.
Last Pay Date: *
19.
Drivers Licence Number *
20.
Drivers Licence State: *
21.
Drivers Licence Expiry Date: *
22.
Date of Birth: *
23.
Nominate Bank:
24.
Bank BSB Number: *
25.
Bank Account Number: *
26.
Bank Address:
27.
Is this a Joint Bank Account? *
Yes
No
28.
ABN Number Self Employed Only