Borrower

Co-borrower (if any)

  Mr   Mrs   Miss    Ms 

  Mr    Mrs   Miss   Ms 

 Name: 

  Name: 

 Age :           

  Age :           

 Smoking :    yes   no

  Smoking :    yes   no

 Credit history :  Select Clear CCJ's IVP's Bankrupt Mortgage Arrears Other I don't know

 Credit history :  Select Clear CCJ's IVP's Bankrupt Mortgage Arrears Other I don't know

 Gross annual income:   £

 Gross annual income:  £

Mortgage details

 Value of the property

  £

 Mortgage required £

  £

 Terms required

     years

 Type of mortgage

     Repayment ISA / Pension Interest only Endowment I don't know

First time buyer ?

     yes   no

Do you have a penalty to move from a current mortgage ?

  If yes, how much ?

 £

Property details

Have you found the property ?

     yes   no

Have you sold your existing property ?

     yes   no

Contact details

Home telephone number * :

 * required

 Work telephone number : 

 Mobile telephone number : 

 Best time to call :

 Email * :

 * required

Address * :

 * required

Postcode :

 * required

Additional information (if any)