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Please fill in the application form below.
Fields marked with a * are required.
Full Name Client 1:
Mr
Mrs
Miss
Ms
Dr
*
Full Name Client 2:
Mr
Mrs
Miss
Ms
Dr
Date of Birth Client 1: (dd/mm/yyyy)
*
Date of Birth Client 2: (dd/mm/yyyy)
Email Address:
*
On Electoral Role:
Yes
No
*
Does Client 1 Smoke ?
Yes
No
For Life Insurance Purposes (only)
Does Client 2 Smoke ?
Yes
No
For Life Insurance Purposes (only)
Home Phone:
*
Work Phone Client 1:
Work Phone Client 2:
Mobile Phone Client 1:
Mobile Phone Client 2:
What is the best time for a Mortgage Professional to contact you to help sort out your Ideal Mortgage ?
Morning
Afternoon
Evening
Anytime
Preferred Time:
Who should they best Contact to discuss your Mortgage Requirements ?
Client1
Client2
Resident UK Area:
England
Scotland
Wales
N.Ireland
UK Home Address:
*
UK Postcode:
*
Mortgage Type Required:
Re-mortgage
New Purchase
But to Let
Equity Release
Other
Buy to Let mortgages are not regulated by the Financial Services Authority.
Property Purchase/Valuation Price: £
Mortgage Sum Required: £
Mortgage Duration Required:
5-10 Years
10-15 Years
15-20 Years
20-25 Years
25+ Years
Property Position:
1
st
Time Buyer
Buy to Let
Property Sold
On Market & Under Offer
On Market & Not Under Offer
Not Yet On Market
Other
Mortgage Option Required:
Variable Rate
Fixed Rate
Discount Rate
Capped Rate
Flexible Rate
Cashback Rate
Current Account
Other
How Soon Do You Need The Mortgage:
0 - 2 months
2 - 4 months
Mortgage Redemption Penalty ?:
Yes: 
No:
If ticked yes, approximately how much:
Existing Mortgage Outstanding:
First Time Buyer
< 30k
30 - 50k
50 - 75k
75 - 100k
100 - 125k
125 - 150k
150 - 175k
175 - 200k
200 - 225k
225 - 250k
250 - 275k
275 - 300k
300 - 325k
325 - 350k
>350
Current Mortgage Lender:
Credit Problems (eg CCJ's):
Yes:
No:
Satisifed?
Yes:
No:
Client 1 - Current Annual Gross Salary: £
p/a.
Employed:
Self Employed:
*
Client 2 - Current Annual Gross Salary: £
p/a.
Employed:
Self Employed:
Deposit Available: £
By submitting this application form/mortgage enquiry I/We agree that:-The information provided is true and accurate and I/We understand that we will be contacted by a member/broker of Mortgage Decisions.
I Agree
Typical APR for Adverse Credit Rated Mortgages is 8.9%
"Please tick box if you wish to be contacted about our whole of market mortgages and associated protection products."
YOUR HOME MAY BE REPOSSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON A MORTGAGE OR ANY OTHER DEBT SECURED ON IT.
Mortgage Decisions is Directly Authorised by the Financial Services Authority FSA No 469503