Title: 
First name:
Enter name eg. John		*
Family name:
Enter surname eg. Smith		*
Date of birth:
Select DoB		*
Please enter your current address:
Enter address		*


Postcode:
Enter Postcode eg. AB1 2CD		*
Daytime phone number:*?
Evening phone number:*?
Mobile phone number:
We require ANY two phone numbers		*
Best time to call:Select time of day
Email address:
Enter email eg. joe@example.com		*?
Do you want to:
Select the mortgage type you require - purchase, remortgage, or buy-to-let		* Buy a property?
Remortgage a property?
Buy a property to let?
Have you found a property?
Select yes or no		*Yes No
Are you a first time buyer?
Select yes or no		*Yes No
In which country?
Select country		*
Do you need to self certify your income?
Select yes or no		*Yes No?
Have you:
Been declared bankrupt?
Missed a loan or mortgage payment in last 12 months?
Had a CCJ or IVA issued against you?
?
What is the estimated value of the property?
Enter property value, eg. 120,000		*?
How much would you like to borrow?
Enter mortgage size, eg. 100,000		*
The amount you want to borrow is more than % of the value of the property value.
You can borrow up to £ on a property of this value, and you will require a deposit of at least £.
How soon do you need your mortgage?
Select number of months
How long do you need the mortgage for?
Select number of years
Please use this space to tell us the best time to call you and any other info you may wish to add:
Yes, I am actively seeking a mortgage and would like to discuss my needs with a mortgage consultant who will contact me by telephone.
Unfortunatly we cannot find a suitable broker for mortgages of this type. Please submit to contine to a popular list of other mortgages providers who may be able to help. Based on your mortgage requirements we have selected the FSA regulated broker "" to help you with your enquiry. Please click submit to confirm that you are happy for them to contact you by telephone. Due to your borrowing requirements being lower than our minimum for a mortgage, we suggest a secured loan from the FSA regulated broker "". Please click submit to confirm that you are happy for them to contact you by telephone.
You voluntarily choose to provide personal details to us via this website. Personal information will be treated as confidential by us and held in accordance with the Data Protection Act 1998. You agree that such personal information may be used to provide you with details of services and products in writing, by e-mail, or by telephone.
 
Phone numbers

If receiving a daytime call from a mortgage consultant during a weekday would be inappropriate, please note this in the "other information" box at the end of the form.
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Email address

We ask for your email address so we can send confirmation of which mortgage consultant will contact you, and so that they can contact you by email if necessary. You will not be sent anything you have not asked for!
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What is the estimated value of the property you want to buy?

This is the estimated value of the property you want to buy or remortgage. Please give a figure to the nearest thousand pounds.
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Do you need to self certify your income?

Self-certification mortgages are available to self-employed people, and also to some who are employees, who find it difficult to prove their income. This may be for a number of reasons, such as:
  • accounts do not reflect their current income
  • accounts are not readily available from an accountant
  • income is made up of bonuses
  • income fluctuates
  • income is made up from dividends
  • income comes from more than one source
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Had a CCJ or IVA issued against you?

A CCJ is a County Court Judgement, this could be issued to you if you owe someone money.

An IVA is an Individual Voluntary Arrangement, this allows someone who is bankrupt to continue in business so they can pay the debts.
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