Please complete as many details as possible and then click "Submit" (please note * indicates this information MUST be filled in)
Applicant 1 Details:
Name*:
Daytime Tel*:
Evening Tel:
Mobile Tel:
E-Mail Address:
Address:
PostCode:
Age:
Marital Status:
Employment Details:	Please Select an Option Employed Self Employed
How long with this Employer:
Annual Salary:
Can income be verified:	Please Select an Option Yes No
Accountant's Name: (if self employed)
Applicant 2 Details:
Name:
Daytime Tel:
Evening Tel:
Mobile Tel:
E-Mail Address:
Age:
Marital Status:
Employment Details:	Please Select an Option Employed Self Employed
How long with this Employer:
Annual Salary:
Can income be verified:	Please Select an Option Yes No
Accountant's Name: (if self employed)
Loan Details:
Loan Required:
Purpose of Loan:
Estimated valuation of your home:
Purchase Price:
Date purchased:
Current lender:
Mortgage balance outstanding:
How long with lender:
Do you have an Existing 2nd charge or caution:	Please Select an Option Yes No
If Yes, how much :
Do you have any Early Repayment Charges: (if applicable)	Please Select an Option Yes No
If Yes, how much :
Property Details:
Property Type:	Please Select an Option House Flat Maisonette Bungalow
Freehold / Leasehold:	Please Select an Option Freehold Leasehold
If leasehold, remaining lease term:
If flat how many floors in the block:
Is the property above a commercial premises:	Please Select an Option Yes No
Construction:
Ex Council:	Please Select an Option No Yes
Applicant 1 Credit History:
Any mortgage arrears in the last 12 months:	Please Select an Option No Yes
Number of arrears outstanding:
Any secured loan arrears in the last 12 months:	Please Select an Option No Yes
Do you have any CCJs:	Please Select an Option No Yes
Do you have any Defaults:	Please Select an Option No Yes
Have you ever been made Bankrupt:	Please Select an Option No Yes
If yes - when discharged:
Have you ever entered an IVA:	Please Select an Option No Yes
Additional notes:
Applicant 2 Credit History:
Any mortgage arrears in the last 12 months:	Please Select an Option No Yes
Number of arrears outstanding:
Any secured loan arrears in the last 12 months:	Please Select an Option No Yes
Do you have any CCJs:	Please Select an Option No Yes
Do you have any Defaults:	Please Select an Option No Yes
Have you ever been made Bankrupt:	Please Select an Option No Yes
If yes - when discharged:
Have you ever entered an IVA:	Please Select an Option No Yes
Additional notes:
What is the best time to call you back?:
Think carefully before securing other debts against your home. Your home may be repossessed if you do not keep up repayments on a mortgage or any other debt secured on it.