Application Form

*required fields

E-Mail Address*

Loans Details

Amount You Want To Borrow
Loan Period
Purpose of Loan
Where Did You Hear About Us?

Applicant 1 Details

Mr/Mrs/Ms/Miss
First Names
Surname
Date of Birth
Address
Town
County
Post Code
Home Phone No.
Work Phone No.
How Long At This Address
Number Of Dependants
Marital Status
Previous Address if Less Than 3 Years at Above
Post Code

Applicant 2 Details

Mr/Mrs/Ms/Miss
First Names
Surname
Date of Birth

Applicant 1 Employment and Income Details

Employment Status: i.e. empl. s/empl.
Occupation
Time in Present Job
Employers/ Accountants
Annual Income
Other Income
Details

Applicant 2 Employment and Income Details

Employment Status: i.e. empl. s/empl.
Occupation
Time in Present Job
Employers/ Accountants
Annual Income
Other Income
Details

Outgoings and Mortgage Details

First Mortgage

Mortgage Type
Est Balance Outstanding*
Monthly Payments
Current Arrears (if Any)*
Account Number
Building Society or Bank

Second Mortgage

Mortgage Type
Est Balance Outstanding*
Monthly Payments
Current Arrears (if Any)*
Account Number
Name of 2nd Lender

Property Details

Purchase Date
Price Paid*
Valued at Today
Freehold/ Leasehold
No. of Bedrooms
Property Type i.e. Semi-Detatched House Flat
Council Purchase	yes no

Credit History

CCJ's

How Many?
What For?

Defaults

How Many?
What For?

Outstanding Loans

How Many?
Who With
How Much?

Outstanding Credit Cards

Which Company?
Balance
Which Company?
Balance
Which Company?
Balance