Loan Application

You must complete this form in full before any loan decision can be made. When you apply for a loan you usually know why you need it and how much you would like. You should be confident that you can afford any repayments on loan and other credit. If you experience any issues with applications made on mobile and tablet devices, please call our Head Office on 01207 232351 to check we have received your application. We may request further information separately to process your application.

Select Title:*

Date of Birth:*

Current Address:

Years at Address:*

Previous Address:

(If you have spent less than 3 years at current address above)

Years at Address:*

Occupancy Type*

Name of landlord / Mortgage Provider:

Number of Dependants:*

Already a Member?:*

Membership Number:

Loan Details:

Loan Required:*

Purpose of loan (explain fully):*

Repayment Method?:*

Repayment Frequency:

Judgement and Arrears:

County Court Judgements:*


Rent or Mortgage Arrears?:*


Details of anything you have answered yes to; we will consider all circumstances:*

Employment and Other Income:

Employment Status:*

Employers Address:*

Employers Phone Number:*

Date Employment Commenced:

Salary £:

Other Income:

Choose main source of other income from drop down list above and enter the amount you receive (and details of any other benefits received) in the Details Box below.

Regular Outgoings:

Mortgage/Rent £:

Council Tax £:

Gas £:

Electric £:

Water Rates £:

Mobile/Broadband £:

Sky/Virgin £:

TV License £:

Food/Household £:

HP/Credit Cards/Store £:

Other Fines £:

Other Loan £:

Childcare £:


Contents Insurance:

Life Insurance:

Car Insurance:

Pet Insurance:

Other Borrowing:

Other Loans:

Credit Cards:


Please provide details of selections above:

Information to Support Your Application:

How did you learn about us (you must select an option):*

By submitting this form, I declare that all the information I have entered on this is true and accurate to the best of my knowledge. Falsifying information will result in your loan application being declined. We may request further information to process your application, so please make sure you provide a valid email address.

Important: Your Personal Information

We may use credit reference and fraud prevention agencies to help us make a decision to lend money