Gilrose Finance Application

Thank you for choosing finance for your purchase. For online and in store finance we use Gilrose Finance.

To get approval for finance please fill out the form below which takes only 5 minutes to complete. We will have an answer back to you by phone or email within approximately 1 hour of submitting this form during business hours (9am till 9pm Monday - Friday, 9am till 7pm Saturday and Sunday)

If you have any question relating to this form or online purchases please contact our Head Offices in Upper Hutt (04 528 8245, sales@dwights.co.nz)

Dwights Outdoors offers finance online and in instore.

Finance is only available on orders $599.95 and over.

Note:
All required fields have a red * beside them.
Press TAB to go to the next field.

Product Information; Please list finance items (eg. Homestead Tent $3399.95)
Item 1 *
Item 2
Item 3
Item 3
Item 5
Item 6
Item 7
Total Value of Goods *
Shipping Cost * Click here for shipping costs
Total Value *
Deposit
Term (Months) *
Payment Frequency *
Interest Free Term: Click here to work out your repayments

Purchaser Information
Title *
Given Names *
Middle Names *
Surname *
Proof of Identity *
ID Number *
Date Of Birth * (eg. 31/01/1980)
Vehicle Registration Number

Customer Information; Physical Address
Street Address *
Suburb *
Town/City *
Post Code *
Time Spent at Above Address *: Previous Address (if less than 3 years at above address):
Full Address
Time Spent at Above Address: Postal Address (if different to physical address)
Street Address
Suburb
Town/City
Post Code: Contact Details
Home Phone *
Is the number above listed in your name? *: Yes

No
Mobile Phone No
Email *: Employment
Employment Status: *
Occupation
Work Phone No
Employers Name
Time With Above Employer
Position
Previous Employers Name
Previous Employers Phone Number
How Long At Previous Job: Next of Kin Address (not living with you)
Next Of Kin Name *
Next Of Kin Address *
Next of Kin Phone No *: General
Marital Status: *
Name of Partner
Number Of Dependants
Personal Weekly Income * (Before Tax – Applicant Only)
If Other (specify)
Do You Have Content Insurance?: Yes

No
Insurance Company Name
Home Owner *: Yes

No
Value of Home (Approx)
Balance Of Mortgage (Approx)

Credit Reference - Loans Outstanding: ($Approximations Only); Loan One Details
Name of Company
Original Balance
Balance Owing
Monthly Payments: Loan Two Details
Name of Company
Original Balance
Balance Owing
Monthly Payments: Loan Three Details
Name of Company
Original Balance
Balance Owing
Monthly Payments: Loan Four Details
Name of Company
Original Balance
Balance Owing
Monthly Payments

Privacy Act

Credit Reporting Privacy Code 2004

I hereby authorise any person or company to provide you or Gilrose Finance Co Limited with such information as you may require in response to your enquiries associated with this application. I also further authorise you to furnish to any third party or parties details of this application and any subsequent dealings that I may have with you as a result of this application being actioned by you. I hereby declare that the information provided is true and correct and that I am not an undischarged bankrupt. I agree that the financier may nominate the insurer at its discretion. I understand that Gilrose Finance Company Ltd have asked me for personal information about me so as to use Veda Advantage's credit reporting service to credit check me. I understand that:

Veda Advantage will give you information about me for that purpose. You will give my personal information to Veda Advantage, and that Veda Advantage will hold that information on their systems and use it to provide their credit reporting service. When other Veda Advantage customers use the Veda Advantage credit reporting service, Veda Advantage may give the information to those customers. If I default in my payment obligations to you, information about that default may be given to Veda Advantage, and Veda Advantage may give information about my default to other Veda Advantage customers.