Lombard Visa Card Application Form


Store Location (if applicable):


Personal Details

Residential Details

Living Status*

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)


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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