Lombard Visa Card Application Form

 

Store Location (if applicable):

$

Personal Details
















Residential Details






 
Living Status*
Owned
Buying
Renting
Parents
Boarding









Previous Address if current address under 3 years)







 


Employment Details (3 years minimum history required)

Applicant 1 - Current Employer






 
Applicant 2 - Current Employer






 
Applicant 1 - Previous Employer






 
Applicant 2 - Previous Employer






 

Income Details (if self employed, please provide name and phone # of your accountant)














Motor Vehicle Details








Credit Card Details










Please Show All Other Loan Commitments










Identity Verification

Primary ID
Document Type:*




Secondary ID
Document Type:*




 
Document Type:



Secondary ID
Document Type:





Personal References (2 relatives not living with you)










Disclaimer

By submitting this application, I/we declare that the information in this application is true and correct, that I am a permanent Australian resident and have never been declared bankrupt and that I/we agree to the terms of the Privacy Statement and Consent.
Click here for The Privacy Act and Consent.
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