Loan Application Form

Please FAX FREE on 0808 178 0771 or post to: 834 Dunstable Road, Luton LU4 0HG

You will need to send us (copies only):

  • Last 2 full months bank statements
  • Last 2 pay slips
  • A clear copy of some photo ID, such as passport or driving licence
  • 2 utility bills dated within the last three months
  • A copy of both sides of your bank cards

Are you self-employed? *
Yes No
Are your wages paid directly into your
bank account by your employer? *
Yes No
Do you have a Debit card? *
Yes No
Type of card? *
 
 
Bank * Card *
How long have you had this account?   Years *
Months *
Do you have any other Debit or Credit cards? *
Yes No
Debit card:  Bank *
Card: *
Credit card:  Bank *
Card: *

Personal Details
Title *
First Name *
Surname *
Date of Birth *
dd/mm/yyyy
Address *
Postcode *
Status *
How long have you lived there?  Years *
Months *
Home phone *
Mobile phone *
Email *
How did you hear about us?

Nearest Relative's Details (not at same address)
Full Name *
Relationship to you (ie. father, cousin, brother, etc) *
Address *
Postcode *
Contact number *

Employment Details
Company Name *
Job Title *
Company address *
Work phone number *
Ext.
Length of employment:   Years *
Months: *
Pay Frequency *
Your LAST Pay date *
 
  dd/mm/yyyy
Your NEXT Pay date *
 
  dd/mm/yyyy