CORPORATE DETAILS

Username:* Check Availability
Password:*
Company Name:*
ACN/ABN:*  
Date of Incorporation:*
Trading Name:
Registered Address:
State:
Business Address:
State:
Mailing Address:*
State:
Telephone: ( )
Facsimile: ( )
Mobile Phone Number (for SMS messages on loan application status):
Email:*
Primary Contact:
Directors/Principals:  
Date of Birth:
Date of Birth:

BUSINESS DETAILS

Years in Finance Industry:
Current Accreditations with other Lenders:
Please supply the names and phone numbers of three references from the finance industry : 1.
2.
3.
Please supply the name of the BDM who recommended you to Mortgage Ezy:

PROFESSIONAL INDEMNITY INSURANCE DETAILS

Insurance Company:
Amount of Cover: $
Expiry Date:

BUSINESS STATUS & ACCOUNT DETAILS

What is your ABN?:
Are you registered for GST?: Yes No
For prompt payment of commission, we credit payments directly into your Bank account. Please supply your Bank account details:
Bank & Branch:
Name on Account:
BSB:
A/c No:
(Please post a deposit slip to supplement this application)
Do you authorise Mortgage Ezy Pty Ltd to produce Recipient Created GST invoices on your behalf?: Yes No

If you agree to this, you acknowledge that:

1. Mortgage Ezy Pty Ltd can issue tax invoices in respect of the supplies;
2. You will not issue tax invoices in respect of the supplies; and
3. You are registered for GST at this time, and will notify Mortgage Ezy if you cease to be registered.

ATTACHMENTS

Please post with this application copies of the following documents:

· A minimum of one Lender's Accreditation Certificate :
 *
· Proof of having passed the UCCC Test OR copy of the Mortgage Ezy UCCC Test *
· Copy of your PI Insurance policy and Certificate of Currency *


EXECUTION

We, the undersigned, hereby make application to become an approved Intermediary of Mortgage Ezy Pty Ltd and confirm that the signatories below are current authorised principal officers, directors or company secretary of the applicant company. We confirm the particulars supplied in this application, including the attachments, are to the best of our knowledge, true and correct.

Signed By:
Date: 
Signed By:
Date: