Personal Details
Loan Amount Required *
minimum amount £2000
Title*
Mr
Mrs
Miss
Ms
Dr
First Name
Surname
Date of Birth
Marital Status*
Please Chose
Married
Single
Seperated
Divorced
Widowed
Co-Habiting
Current Address*
Current Postcode*
Have you been at this address for less than 4 years?
Yes
No
Time at Current Address (Yrs/Mths)*
Previous Address(if less than 4 yrs at current)
Previous Postcode
Time at Previous Address (Yrs/Mths)
Property*
Owner
Private Tennant
Council Tennant
Living with Parents
Other
if other Please Specify
Telephone*
Mobile Number
Email Address*
Driving Licence*
Full UK
Provisional
EEC
International
No. of Dependants
Additional Information
Vehicle Details
(only to be completed if you have found a car yourself)
Make
Model
Registration Number
Colour
Mileage
Year Manufactured
Cost
Employment Details
Status*
Employed
Self-employed
Pension
Other
If other please specify
Occupation / Title
Company Name
Company Address
Company Postcode
Telephone Number
Fax Number
Hours
Full Time
Part Time
Net Monthly Income £*
Paid
Weekly
Monthly
Paid by
Cash
Cheque
Transfer
Wage Slips
Yes
No
Computerised
Yes
No
Time in Employment (Yrs/Mths)
Previous Occupation if less than 3 years with current employer
Previous Employer Name and Address
Previous Employers Postcode
How Long?
Previous Employment details 2
Please complete if employment details total to less than 3 years
How Long?
Are you receiving a car allowance?*
Yes
No
If so how much per month? £
Additional Information
Have you ever had Late payments?
Yes
No
Not Sure
Do you have any defaults?
Yes
No
Not Sure
Do you have any CCJs?
Yes
No
Not Sure
Debt Managment program
Yes
No
Not Sure
IVA
Yes
No
Not Sure
Are you currently or ever been bankrupt?
Yes
No
Not Sure
We are a company that specialises in helping those with past or present credit problems. This information will not affect your application. It is to help us speed up the process.
Name of Bank
Time with bank
General details
Where did you see us advertised?*
Please Choose
Google
Gumtree
Text Message
Car Dealer Refferal
Other Search Engine
Previous customer refferal
Other
If other, please specify
Customer Declaration
Data Protection
The information that you have provided on this form will be disclosed to lenders for the purpose of considering your credit application. Lenders may use this information to carry out searches with credit reference agencies. A record of these searches will be kept and may be used by other lenders in assessing applications from you and other members of your household for credit in future. Lenders will cross check this information with other lenders to prevent fraud.
I hereby confirm that all the details on this form are correct and give my permission for searches to be carried out*
Yes, I do agree