Step 1

Title: Mr Mrs Miss Ms

Last Name : First Name:
* *

Number of Cards: 0 1 2 3 4 5 6 7 8 9 10 Number of Loans: 0 1 2 3 4 5 6 7 8 9 10

Step 2

Was your Credit Card/s and/or Loans/s issued before April 2007 Yes No Not Sure

Is your outstanding balance between £2,000 - £25,000? Yes No Not Sure

Do you have any history of Late payments or Arrears? Yes No

Step 3

Personal Details -

Contact Number: Mobile:
Email: House Number:
Street Name: Town:
County: Post Code: