BFL CAPITAL

INTRODUCER/DEALER/BROKER DETAILS
* These fields are required
*Introducer Name/Company
*Introducer Contact Person
*Contact Phone Number
*Contact Email

AUTHORISED SIGNATORY DETAILS
Position Held
Name of Government Dept
Nature of Business
* Family-name
* First-name
Middle-name
* Gender	Male Female
Current Residential
* Street-number
*Street-name
* Suburb
* State
* Post Code
* Drivers-license-number
Date-of-birth	Years Months Days
* Work Phone
Fax
Mobile

Email

APPLICANT PARTNERSHIP DETAILS
Occupation
* Name of Legal Entity in full
*ABN
* Street-number
*Street-name
Suburb
* State
* Post Code
Years Trading	Years Months
Previous Employer (if less than 3 years trading)
Years Trading	Years Months
Number of Employees
Gross Profit $
Gross Turnover $

SOLE TRADER/SELF EMPLOYED DETAILS
Occupation
*Name of Legal Entity in full
*ABN
* Street-number
*Street-name
Suburb
* State
* Post Code
Years Trading	Years Months
Previous Employer (if less than 3 years trading)
Years Trading	Years Months
Number of Employees
Gross Income $
Gross Profit $

EMPLOYED INDIVIDUAL
* Family-name
* First-name
Middle-name
* Gender	Male Female
Current Residential
* Street-number
*Street-name
Suburb
* State
* Post Code
*Home Phone
* Work Phone
Fax
Mobile
*Occupation
*Employer
*Years Employed	Years Months
*Previous Employer (if less than 3 years trading)
*Years Employed	Years Months
*Gross Annual Salary$
* Drivers-license-number
* Date-of-birth	Years Months Days
Email

* Name of Legal Entity in full	Please do not enter the organisation type i.e. Pty Ltd
Nature of Business
Australian Company Number (ACN)
* ABN
* Years est.
* Street-number
*Street-name
* Suburb
* State
* Post Code
Turnover $
Number of Employees
Time under current owner	Years Months
Net Profit $

ADDITIONAL DETAILS
The following information is not compulsory, however, BFL Capital may require these details at a later time and providing the information now may avoid future delays.
Accountant Company Firm Name
Contact Person
Phone Number
Authority to contact your accountant for information if required
	Yes No

PERSONAL DETAILS – 1st PERSON
To be fully completed by directors/partners/individuals NOT required for government or top 500 companies
* Family-name
* First-name
Middle-name
* Gender	Male Female
* Street-number
*Street-name
* Suburb
* State
* Post Code
Drivers License
*Date of Birth
Phone Number
Annual Income
REAL ESTATE DETAILS
Are you a	Renter or Home Owner
Value $
Mortgage $
Previous Address (if less than 3 years at current address)
Length in years	Years Months

Are There Any More Partners/Directors

Yes No

PERSONAL DETAILS – 2nd PERSON
To be fully completed by directors/partners/individuals NOT required for government or top 500 companies
* Family-name
* First-name
Middle-name
* Gender	Male Female
* Street-number
*Street-name
* Suburb
* State