Online Application Form

Information Request

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LOAN AND SECURITY

Net loan required :

Purpose of your loan :

Address and post code of the property :

Description of the property :

Estimated Value or purchase price :

FIRST APPLICANT - DETAILS

Full name :

Current address including post code :

Any other addresses in the last three years :

Date of birth :

Marital status :

National Insurance number (if known) :

Land line telephone number :

Mobile telephone number :

Best email address for contact :

Your employer’s or business name :

Your employer’s or business address and post code :

Work telephone number :

Your work email :

Your job or business :

Length of time employed or in the business :

Your income before tax in a year :

Any other income in a year :

Details of where your other income comes from :

SECOND APPLICANT - DETAILS

Full name :

Current address including post code :

Any other addresses in the last three years :

Date of birth :

Marital status :

National Insurance number (if known) :

Land line telephone number :

Mobile telephone number :

Best email address for contact :

Your employer’s or business name :

Your employer’s or business address and post code :

Work telephone number :

Your work email :

Your job or business :

Length of time employed or in the business :

Your income before tax in a year :

Any other income in a year :

Details of where your other income comes from :

YOUR EXISTING BORROWINGS - secured on your properties (If any secured amount is an overdraft please state payment as nil or insert the word overdraft in the payment box)

Name of first lender :

Address :

Amount you owe :

Monthly payment :

Account number if known :

Name of second lender :

Address :

Amount you owe :

Monthly payment :

Account number if known :

PROFESSIONAL ADVISERS - we do not contact any of these without your consent

YOUR ACCOUNTANT - if you do not have an accountant please ignore this.

Name of who looks after you :

Name of his or her firm :

Its address :

Telephone number :

YOUR SOLICITORS

Name of who looks after you :

Name of his or her firm :

Its address :

Telephone number :

DIRECT DEBIT DETAILS TO PAY YOUR NEW LOAN

Name of bank :

Address :

The name of the account :

Account number :

Sort code :

FURTHER INFORMATION - please tell us anything else that you want us to know. For example, if you own any other property tell us about this and whether or not there is a mortgage on it, or if you believe you might have an impaired credt history please tell us here. The more information, the better.

Please note that by submitting this form you are agreeing to the use of your personal information as set out in
the Data Protection Act 1998. Click here to read details.

Please enter the words you see in
the box, Doing so helps prevent
automated programs from abusing
this online form.

I have read and understand the terms of the Data protection Act, as above.

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