Customer Application

Answer all questions marked *

This form must be completed in full, incorrect or inaccurate data will delay our response.
Please call 0800 279 1279 if you require assistance

*Marital Status of Applicant

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*Resident status of Applicant

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*Amount of loan required

*Repayment term required

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*Purpose of loan

1st Applicant Details

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*Full Name

Please state Mr/Mrs/Miss/Ms

Maiden Name (if applicable)

*Date of Birth (in the following format dd/mm/yyyy)

*Postcode


*Full Address

Previous postcode - if you have been at your current address for less than 3 years.


Previous Address in full:

*Do you have a Home Telephone number (landline):

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Home Telephone

Work Telephone

Mobile Telephone

*Email address (IF NONE STATE "NONE")

*Employment Status

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If other or benefits please specify

*Time with current employer/self employed

Years / Months

*Average Gross Annual Earnings (Average Before Tax)

*How long have you held your present bank account?

Have you had any court orders/defaults/debts registered? IVA or Bankruptcy?

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If yes, state number of court orders/defaults/debts in last 6 years

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2nd Applicant Details

Click Here - If applicant is married or property is jointly owned with another person
If not, please go to next section

THE FOLLOWING INFORMATION MUST BE COMPLETED:

Full Name

Please state Mr/Mrs/Miss/Ms

Maiden Name (if applicable)

Date of Birth (in the following format dd/mm/yyyy)

Employment Status

select

If other or benefits, please specify

Time with current employer

Years / Months

Average Gross Annual Earnings (Average Before Tax)

Have you had any court orders, defaults or debts registered? IVA or Bankruptcy?

select

If yes, state number of court orders/defaults/debts in last 6 years

select

Property Details

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Address of property to be used as security (if different from home address)

*Type of property

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If other please specify

*Approximate value of the property now

*Date you purchased the property

*Price you paid for the property

*Is the property ex-council?

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If yes, how much discount was given?

*Who lives in the property?

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*Is the property tenanted?

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If yes, state monthly rent received.

Mortgage Details

Answer all questions marked *

*Name of mortgage company

*Approx sum owing on mortgage

*Monthly Mortgage payment

*Has there been any mortgage arrears in the last 12 months?

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If Yes, please state the Approximate amount of Arrears owing now?

£

Tick which months were missed in the last 12 months:  
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Existing Secured Loan

Click Here - If you have an existing secured loan
If not, please continue

*Name of Loan Company

*Amount outstanding

*Has there been any loan arrears in the last 12 months?

select

If Yes, please state the Approximate amount of Arrears owing now?

£

Tick which months were missed in the last 12 months:  
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Information and Notes

Insurance protection is NOT included with your loan, if you require cover we recommend you seek the services of a professional insurance provider.

Please write in the box below any notes you think may be relevant to your application.

padlockDisclosure & Use Of Your Information

Please read the Data Protection notice by clicking here

Tick box to confirm acceptance of the Data Protection Notice.

Tick box if applicants do not wish to receive correspondence/information offering other products that may be of interest to them.

Click the 'Send Application' button once, it may take a few seconds to process your details

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