Online Application Form

Information Request

If you prefer us to fill in this form for you, please do not hesitate to call us or to ask any questions about it.

You also have the option to print this Form and complete it by hand.

If you prefer this option, please also download our CUSTOMER FAIR PROCESSING NOTICE – YOUR DATA AND WHAT WE DO WITH IT – GDPR POLICY
Or you can read it online by clicking the following link GDPR POLICY

Download this Form as Word Doc

Download this Form as PDF

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.

By ticking this box you acknowledge you have read and agree to how we collect and use your data - CUSTOMER FAIR PROCESSING NOTICE - YOUR DATA AND WHAT WE DO WITH IT - GDPR Policy Yes, I have read and agree to how my data will be collected and used by Farm & Country Finance. In addition, in the future we would like to occasionally get in touch with you for the following reasons: To send information that may interest you generally. To send information about only our services. To extend compliments of a season - for example at Christmas This is one of the areas of the data protection laws for which we need your specific consent. If you would like to hear from us then please let us know how by ticking the boxes below to show which way you would like us to stay in touch. If you change your mind you can contact us at any time to change your preferences. Email Yes please No thanks Phone Yes please No thanks SMS Yes please No thanks Post Yes please No thanks

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