Loan Enquiry FormLoan Enquiry Form v4 How did you hear about us? * Please select …GoogleFriendFamily MemberExisting CustomerComparison Site Your friend or family member * Please supply the full name of the person that recommended you. Amount you’d like to borrow * £ Please select …100150200250300350400450500 * Credit limits are subject to an affordability assessment. Reason for needing the loan … * Please select …One-off PurchaseHolidaySpecial OccasionHome Appliances / RepairsHome Improvements / RepairsVehicle Expense / RepairsFuneralRent / UtilityUnexpected BillsBaby / Child CostsMedical / DentalEducationBusiness Expenses Please specify … * How much you can afford to pay * £This is the amount you can afford to pay each week, fortnight or month How often you want to pay * Please select …WeeklyFortnightlyFour-weeklyMonthly Personal detailsWe need to know about your personal details and living situation Title * Please select …MrMrsMissMs First name * Last name * Date of birth * Email * Mobile no. * Landline no. (if applicable) Marital Status * Please select …MarriedSingleDivorcedLiving with PartnerWidowedSeparated Number of dependents * Please select …012345 or more Children who are financially dependent on youPlease check the Areas We Cover page to see if we cover your area. (opens in new tab) Residential Status * Please select …Home OwnerPrivate TenantCouncil TenantHousing AssociationLiving with ParentsOther Home Address * Home Address Home Address Town Town Postcode Postcode Time at your current address * Please select …Less than 1 year1 – 2 years2 – 3 years3 – 4 years4- 5 years5 years or more Previous Address * Previous Address Previous Address Town Town Postcode Postcode Time at your previous address * Please select …Less than 1 year1 – 2 years2 – 3 years3 – 4 years4 – 5 years5 years or more Your incomeWe want to know about the type of income you receive Employment Status * Please select …Self-employedOn BenefitsRetired Job Title * How long have you been self-employed? * Please select …Less than 1 year1 – 2 years2 – 3 years3 – 4 years4 – 5 years5 years or more How often do you receive your income? * Please select …WeeklyFortnightlyFour-weeklyMonthlyAt different times in the month How often do you receive your income? How often do you receive your benefits? * Please select …WeeklyFortnightlyFour-weeklyMonthlyAt different times in the month Weekly Income (after tax / other deductions) * £ Fortnightly Income (after tax / other deductions) * £ Four-weekly Income (after tax / other deductions) * £ Monthly Income (after tax / other deductions) * £ How much money you receive in total per month? (after tax / other deductions) * £ How much money you receive in total per week? * £ How much money you receive in total per fortnight? * £ How much money you receive in total per four-weeks? * £ How much money you receive in total per month? * £ Are you expecting a reduction in your income in the next 6 months? * Please select …YesNo Please specify … * Have you had a County Court Judgement (CCJ) in the last 5 years? * Please select …YesNo Are you currently entered into any Individual Voluntary Arrangement (IVA), Debt Management Plan (DMP), Debt Relief Order (DRO) or declaring bankruptcy? * Please select …YesNo Do you struggle making financial decisions or understand information? * Please select …YesNo Permissions I’m happy for Brantwood Finance to perform a soft credit search if required to proceed with my application. * Please select …YesNo Please refer to our Privacy Policy for full details on how we use your information. https://www.brantwoodfinance.co.uk/privacy-policy/As part of our application process as we may perform a soft credit search to verify certain information you provide.We will inform you which Credit Agency we have used during the application process.If you answered ‘No’ to this question, we cannont consider your application. I’m happy for Brantwood Finance to contact me by phone or alternatively, visit me at my home address to complete my application. * Please select …YesNo As part of our application process, we require a representative of Brantwood Finance to make contact with you either by phone or in person in order to complete a full application and evidence your income and outgoings.If you answered ‘No’ to this question, we cannont consider your application. I’m happy for Brantwood Finance to send communications by SMS, WhatsApp and Email to provide details about my application, loans and product-specific promotions. * Please select …YesNo We communicate important information to our customers by the above means.If you answered ‘No’ to this question, we cannont consider your application.DisclaimerBy submitting this form I confirm that I am at least 21 years old and a UK resident and that all the information provided is true.Loan amount and length of term requested is subject to change pending an affordability assessment and a review of any supporting documentation provided.Data Protection StatementWe are required by the Data Protection Act to keep your personal details confidential and the information you provide will only be used to make a decision on whether to lend you money.Credit Reference and Fraud Prevention AgenciesWe may check your details and your financial history with credit reference agencies. You will have the right to know which credit reference agency we use. We may also use the information you provide to prevent fraud, money laundering and debt tracing. Submit If you are human, leave this field blank.
