Please fill out all of the fields marked with an asterisk(*). You will need to have a Javascript enabled Internet Browser to complete the application. This form will ask you for all of the details that we need to search for the best quotations. Once you have filled the form in once, we will look at multiple reputable lenders such as central trust, Blackhorse finance, London Mortgage Company and many others. We will get back to you quickly with details of our best no-obligation quote.

1. Personal Details

Your residency situation *	Select Mortgage payer Own home outright Paying rent to landlord Living with parents Shared ownership
Number / Name *
Address Line 1
Town *
County *
Post Code *
Country
Time at address *	0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years Over 20 Years   0 Mths 1 Month 2 Months 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10 Months 11 Months

2. Applicant one Title * Select Mr Mrs Miss Ms Dr Other First Name * Middle Names Surname * Date of Birth * dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 mm Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec yyyy 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Employment Status * Please select Employed Self-employed Unemployed Employed part time Agency worker Retired Disabled Housewife Househusband Receiving Benefits Job title * Employer Name * Time in Job * 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years+ 0 Mths 1 Month 2 Months 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10 Months 11 Months Gross Annual Income * Proof of income * Please select Payslips(Computerised) Payslips(Handwritten) Accountant's Letter Accounts (Chartered) Accounts (Self) Employer's Letter Pension Slips (Private) Pension Slips (State) Self Declaration Tax Returns SE60 Benefits Book Work Telephone Mobile Telephone Home Telephone * Email * Number of children * 0 1 2 3 4 5 6+ Marital Status * Select Single Married Living with partner Divorced Widower Widow

3. Applicant two (if applicable) Select Mr Mrs Miss Ms Dr Other dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 mm Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec yyyy 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Please select Employed Self-employed Unemployed Employed part time Agency worker Retired Disabled Housewife Househusband Receiving Benefits 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years+ 0 Mths 1 Month 2 Months 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10 Months 11 Months Please select Payslips(Computerised) Payslips(Handwritten) Accountant's Letter Accounts (Chartered) Accounts (Self) Employer's Letter Pension Slips (Private) Pension Slips (State) Self Declaration Tax Returns SE60 Benefits Book

4. Loan Details

How much do you want to borrow? *
Over how many years? *	3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years
What is the loan for? *	Please select Home Improvements Debt Consolidation Car Holiday Wedding School Fees Other

5. Property Details

How much did you purchase the property for? *	£
When did you purchase the property? *	dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 mm 01 02 03 04 05 06 07 08 09 10 11 12 yyyy 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Did you buy the property from the council? *	Please select... No Yes
If yes - How much discount did you recieve in cash from the council? *	£
How much would the property realistically sell for today? *	£
Is your property jointly owned? *	Please select... No Yes
What type of propery is your home? *	Please select... Converted Flat Detached Bungalow Detached Cottage Detached House End Terrace House Maisonette Purpose Built Flat Semi Commercial Semi Detached Bungalow Semi Detached House Studio Flat Terraced Cottage Terraced House Townhouse
What is the construction type of your home? *	Please select... Bricks and mortar Concrete Timber Framed Thatched Stone Steel Framed Single Leaf Granite
How many bedrooms does your property have? *	Please select... 1 2 3 4 5 6 7
Do you have a mortgage? *	Please select... No Yes

6. Your Credit Situation

How would you describe your credit record*	Please select... Excellent Good Fair Poor
How many county court judgements (CCJ's) do you have(if any)? *	0 1 2 3 4 5 6 7 or more
Have you ever been bankrupt or do you currently have an Individual Voluntary Arrangement(IVA)?*	Please select... No Yes

Please use the following table to provide details of your existing loans, credit cards and store cards
and whether you wish to clear them with the loan.

Type	Name of company	Balance outstanding	Monthly payment	Settle it?
Please select... Credit Card Store Card Car Loan Bank Loan Overdraft Other				Yes No
Please select... Credit Card Store Card Car Loan Bank Loan Overdraft Other				Yes No
Please select... Credit Card Store Card Car Loan Bank Loan Overdraft Other				Yes No
Please select... Credit Card Store Card Car Loan Bank Loan Overdraft Other				Yes No
Please select... Credit Card Store Card Car Loan Bank Loan Overdraft Other				Yes No
Please select... Credit Card Store Card Car Loan Bank Loan Overdraft Other				Yes No

Please Tell us who you bank with and for how long:

Name of bank *
Time with bank *	0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years+   0 Mths 1 Month 2 Months 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10 Months 11 Months
Please Tell us specifically about your plastic cards:
Access / Mastercard Yes No	Barclaycard/Visa Yes No
American express Yes No	Cheque Guarantee Card ? Yes No
How many store cards do you have? 0 1 2 3 4 5 6 7 8 9	Other credit cards? Yes No

Please initial the below box to confirm the application and that you have read details regarding the Data protection Act