Main personal information
Title:
--- Mr. Miss. Mrs. *
First name:
*
Last name:
*
Date of Birth:
--- 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 --- 01 02 03 04 05 06 07 08 09 10 11 12 --- 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 *
Address Line 1:
*
Address Line 2:
*
City:
Postcode:
*
Length of time at address:
--- Under 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years Over 10 years *
Nationality:
--- UK mainland N.Ireland Other *
Contact information
Best contact number:
--- Home number Mobile number Office number Fax number Friend number Other *
2nd best contact number:
--- Home number Mobile number Office number Fax number Friend number Other *
Best time to call:
from
--- 01 02 03 04 05 06 07 08 09 10 11 12 --- AM PM to --- 01 02 03 04 05 06 07 08 09 10 11 12 --- AM PM *
Job description
Years working in your present industry:
--- Under 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years Over 10 years *
Are you employed or self employed?:
--- Self employed Employed *
If employed, what is the name of your Employer?:
*
Position held in Company:
*
Number of years with the above company?:
--- Under 1yr 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 and more *
If under 1yr, what was the name of your previous employer?:
*
If self employed, give us a description of occupation:
*
If self employed, how long have you been self employed for?:
*
If self employed, can we see income from job coming into bank statement?:
--- Yes No *
Net Monthly income excluding commission/bonus :
--- under £1000 £1000 - £1,300 £1,300 - £1,500 £1,500 - £2,000 £2,000 - £3,000 £3,000 - £5,000 £5,000 - £7,000 £7,000 - £10,000 £10,000 or above *
General information
Please Select Your Residential Status:
--- Homeowner Private Tenant Council Tenant Live with Parents Other *
Do you have a mobile phone contract?:
--- Yes No *
In certain circumstances we may require you to find a suitable Guarantor, (preferably a Homeowner). Would you be able to find such a person?:
--- Yes No *
Do you want all docs emailed or posted:
--- Emailed Posted *
When do you want the Direct Debit to leave your account every month?:
--- Last working day of the month 15th of the month *
*
Please re-enter your Email:
*
Password (Please select a password of at least 7 digits of your choice):
*
Retype password (Please re-enter your password):
*
Data protection Act
Terms of Trade
How did you hear about our company?:
*
