Contact InformationName* First Last Email* Phone Number*Date of Birth* Number of DependantsMarital Status*Please Select...SingleMarriedDefactoSeparatedSpouse/Partners Name First Last Address* Street Address Suburb State Postcode Current Living ArrangementsWhat are your living arrangements?*Please Select...I have a mortgageI am rentingI am currently renting, but I also have a mortgageI have multiple mortgages (investment properties)How much rent do you pay?*Rental Payment Frequency*Please Select...WeeklyFortnightlyMonthlyYour Financial DetailsDo you currently operate a business or own a company or trust?*Please Select...I operate a businessI own a companyI own a trustNoEmployment Status*Please Select...Full TimePart TimeCasualUnemployedYour income amount*Payment Frequency*Please Select...WeeklyFortnightlyMonthlyIndustry*How long have you been in this job?*Please Select...Less than 1 month1-3 Months4-6 Months6-11 MonthsOver a yearHow long have you been unemployed?*Please Select...Less than 1 month1-3 Months4-6 Months6-11 MonthsOver a yearYour last employer (company name)*Debt OverviewI have Secured Debt.*Secured Debt includes any finance secured over an asset (e.g. Home Loans, Car Loans, Leased Equipment or Rental Goods).Please Select...YesNoI have Unsecured Debt.*Please include all Unsecured Debt (Credit Cards, Store Cards, Personal Loans, Overdraft Facilities, ATO Debt & Overdue or Disconnected Bills).Please Select...YesNoSecured Debt*Type of Debt...Creditor NameCard/Account/Reference NumberRepayment AmountRepayment FrequencyAsset ValueJoint?Hardship?Amount Owing Please Select...House MortgageVehicle LoanLeaseEquipment HireBusiness SecurityOtherPlease Select...WeeklyFortnightlyMonthlyPlease Select...YesNoPlease Select...YesNo Unsecured Debt*Type of Debt...Creditor NameCard/Account/Reference NumberRepayment AmountRepayment FrequencyAge of DebtJoint?Hardship?Amount Owing Please Select...Credit CardStore CardPersonal LoanOverdrawn AccountBill of SaleOtherPlease Select...WeeklyFortnightlyMonthlyPlease Select...YesNoPlease Select...YesNo Financial SummaryFinancial Situation*In your own words, please describe how you have arrived in this situationHave you declared Bankruptcy or entered into any other kind of Insolvency Agreement?*Please Select...I have declared BankruptcyI have entered Part 9 Debt AgreementI have entered a Part 10 Debt AgreementI have entered a Personal Insolvency AgreementI have entered a Debtstroyer AgreementI have entered an informal debt agreementNoWhat year was it finalised/terminated? This iframe contains the logic required to handle Ajax powered Gravity Forms.