Mercury CRM Integration Test

Applicant 1 First Name

Applicant 1 Middle Name

Applicant 1 Last Name

Gender

Address

Unit No  / Street No 

Street Name

St Rd Ave Cres Cl Crt Dr Pl Alley Arcade Bend Brace Blvd Bypass Causeway Centre Chase Circle Circus Concourse Corner Corso Cove Crossing Driveway Entrance Esplanade Expressway Freeway Fairway Frontage Garden Gate Glade Glen Grange Green Groung Grove Highway Heights Junction Key Lane Link Loop Motorway Mews Nook Outlook Parade Parkway Pass Path Plaza Point Port Promenade Quadrangle Quadrant Quay Reserve Rest Retreat Ridge Right of Way Rise Roadway Round Route Row Siding Square Terrace Track Trail Turn Tollway View Walk Walkway Way Wynd

Suburb

Date moved in?

Date of Birth

Driver's Licence Number

Exp State ACT NSW NT QLD SA TAS VIC WA

Marital Status

Number of Children

Telephone Home

Telephone Mobile

Email Address

Occupation

Status Full Time Part Time Contract Temporary Commission Seasonal Casual Self Employed Unemployed

Employer's Name

Employer's Address

Unit No  / Street No 

Street Name

St Rd Ave Cres Cl Crt Dr Pl Alley Arcade Bend Brace Blvd Bypass Causeway Centre Chase Circle Circus Concourse Corner Corso Cove Crossing Driveway Entrance Esplanade Expressway Freeway Fairway Frontage Garden Gate Glade Glen Grange Green Groung Grove Highway Heights Junction Key Lane Link Loop Motorway Mews Nook Outlook Parade Parkway Pass Path Plaza Point Port Promenade Quadrangle Quadrant Quay Reserve Rest Retreat Ridge Right of Way Rise Roadway Round Route Row Siding Square Terrace Track Trail Turn Tollway View Walk Walkway Way Wynd

Suburb

Work Phone Number

Date started?

Gross Annual Income

$ per year

Family Allowance etc.

$ per year

Investment Property Rental Income

$ per year

Do you have any other income?

Yes No

Applicant 2 First Name

Applicant 2 Middle Name

Applicant 2 Last Name

Gender

Relationship to Applicant 1

Address (as above )

Unit No   /   Street No 

Street Name

St Rd Ave Cres Cl Crt Dr Pl Alley Arcade Bend Brace Blvd Bypass Causeway Centre Chase Circle Circus Concourse Corner Corso Cove Crossing Driveway Entrance Esplanade Expressway Freeway Fairway Frontage Garden Gate Glade Glen Grange Green Groung Grove Highway Heights Junction Key Lane Link Loop Motorway Mews Nook Outlook Parade Parkway Pass Path Plaza Point Port Promenade Quadrangle Quadrant Quay Reserve Rest Retreat Ridge Right of Way Rise Roadway Round Route Row Siding Square Terrace Track Trail Turn Tollway View Walk Walkway Way Wynd

Suburb

Date moved in?

Date of Birth

Driver's Licence Number

Exp State ACT NSW NT QLD SA TAS VIC WA

Marital Status (as above )

Number of Children (as above )

Telephone Home (as above )

Applicant 2 Mobile Number

Applicant 2 Email Address

Applicant 2 Occupation

Status Full Time Part Time Contract Temporary Commission Seasonal Casual Self Employed Unemployed

Employer's Name

Employer's Address

Unit No  / Street No 

Street Name

St Rd Ave Cres Cl Crt Dr Pl Alley Arcade Bend Brace Blvd Bypass Causeway Centre Chase Circle Circus Concourse Corner Corso Cove Crossing Driveway Entrance Esplanade Expressway Freeway Fairway Frontage Garden Gate Glade Glen Grange Green Groung Grove Highway Heights Junction Key Lane Link Loop Motorway Mews Nook Outlook Parade Parkway Pass Path Plaza Point Port Promenade Quadrangle Quadrant Quay Reserve Rest Retreat Ridge Right of Way Rise Roadway Round Route Row Siding Square Terrace Track Trail Turn Tollway View Walk Walkway Way Wynd

Suburb

Work Phone Number

Date started?

Gross Annual Income

$ per year

Family Allowance etc.

$ per year

Investment Property Rental Income

$ per year

Do you have any other income?

Yes No

Amount you wish to borrow

$ for

How long do you intend to keep this loan?

Years, to

New Home Purchase

Yes No

Yes No

Refinance Current Loan

Yes No

Refi and Payout Other Debts

Yes No

Build New Home

Yes No

Free Up Equity

Yes No

Refinance Business Debt

Yes No

Buy Vacant Land

Yes No

Reverse Mortgage

Yes No

Self Managed Super Fund Loan

Yes No

Other

Do you quailify for the First Home Owners Grant?

Yes No Not sure

Yes No

If Self Employed do you have your most recent tax returns?

Yes No

Do you have credit defaults?

Yes No

Internet\BPay\Phone

Yes No Don't Care

Branchs

Yes No Don't Care

ATM\Eftpos\Debit Card

Yes No Don't Care

Cheque Book

Yes No Don't Care

Other