Your Details

Your Full Name
Title   Full Last Name Full Other Names
Birth Details
Age   Date of Birth  /   /  Place of Birth
Citizenship & Passport No.
Other
Marital Status   Spouse's Full Name No. of Dependants
Age of Each Dependants
Full Home Address
No.  StreetSuburb
State  Post Code
Postal Address if Different
No.  StreetSuburb
State  Post Code
Contact Phone Numbers
Work Phone  Home PhoneMobile
Other Contact Numbers
Fax No.  What are the preferred time for us to call you and on what number?
 Between    and    on  
Are you a Partnership?  Yes  No
Are you a Sole Trader?  Yes  No
Company Name (if applicable)  
Company ABN No.  
List of Directors
Director One
Name
Address
Director Two
Name
Address
Director Three
Name
Address
Director Four
Name
Address
Proposed Location of Dealership Site
No.  StreetSuburb
State  Post Code
What is your current position and role?
Do you have tertiary qualifications?  Yes  No
If yes, describe.
Do you have trade qualifications?  Yes  No
If yes, describe.
Do you have any physical, mental or health problems which may adversely affect your work?  Yes  No
If yes, describe.
Have you ever been convicted or charged with a criminal offence?  Yes  No
If yes, describe.
Have you had any debt, criminal or civil proceedings commenced against you within the last three years?  Yes  No
If yes, describe.
 

 



ROADSTAR ABN: 13 007 382 158