Mortgage Application Please complete the short form below. Please ensure that you will in all required fields marked with an asterisk (*) Title* MrMrsDrMiss Firstname* Surname* Date of Birth* Address 1* Address 2 Town/City* Postcode* Landline* Mobile Best time to contact MorningAfternoonEveningAnytimeASAP Email How much would you like to borrow?* Estimated value of the property* Do you want to* Buy a property?Remortgage a property?Buy a property to let? Have you Had a CCJ or default against you?Missed loan/mortgage payment in the last year?Been declared bankrupt or had an IVA? How soon do you want the mortgage?* ASAP1 Month2 MonthsLonger What term would you like your mortgage over?* 35 years34 years33 years32 years31 years30 years29 years28 years27 years26 years25 years24 years23 years22 years21 years20 years19 years18 years17 years16 years15 years14 years13 years12 years11 years10 years9 years8 years7 years6 years5 years Additional information Yes I am actively seeking a mortgage and would like to discuss my requirements with a Mortgage Underwriter who will contact me by telephone. There is no obligation and no credit search will take place. By completing these details you give us your permission to use this information to contact you to discuss your mortgage requirements. We treat your information with the utmost care and security.