Customer Enquiry Sheet Step 2 – Income and Expenses

Local Appliance Rentals

For the next step we require some income and expenses information from you just to check whether a rental agreement with us is able to go ahead 🙂 Please enter all the information for the FORTNIGHTLY amount.

First Name
Last Name


Do you receive Centrelink Benefits?

If yes, please upload your latest Centrelink Income Statement here - if you have any issues please reply back to the branch that sent you this link 🙂
Do you work to receive income?
If yes, please upload your 2 latest payslips - if you have any issues please reply back to the branch that sent you this link 🙂

Are you applying with your partner in a joint agreement?
For your partner please upload their Income Statement, Payslips or both so they can also be included


For the below questions please enter the amount you would spend for each category FORTNIGHTLY. If you and a partner are completing this as a joint contract please fill this out using the totals for both of you

Phone and Internet?
Insurance/Funeral Fund?
Loans? e.g Car loan, Cash Converters, Money 3 etc
Loan 1

Loan 2

Loan 3

Total of further loans (names and amounts)
Fines? e.g SPER, Court Fines etc
Fine 1

Fine 2

Total of further fines
Child Support?
Do you have a car?
If you do have a car - Car expenses?
Entertainment? e.g Netflix, Foxtel, iTunes
Medical Expenses?
Bank Fees?
Transport? (Only if you don't have a car - taxis, UBER etc)
Any other expenses? e.g Chrisco, Family photos etc
Other Local Appliance Rentals Contracts?

To verify all these expense we will just need to see a copy of your recent 30 days worth of bank statements. There are 2 ways you can supply this information.
1. Download the statement from your bank and upload below
Upload Bank Statements:

2. You can select to use our quick and easy online system all set up via text message. If you select this option the franchisee will be in touch to give you more specific details.
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