MORTGAGE INTRODUCER APPLICATION FORM No Obligation - Same Day Quotation Please Complete ALL The Information Below INTRODUCER DETAILS Contact Name Company Broker Address Telephone Fax Number     Email Postcode     APPLICANT ONE APPLICANT TWO    (If Applicable) Name Name Type Of Loan House Purchase Mortgage Remortgage Right To Buy Mortgage Buy To Let Mortgage Secured Loan Bridging Select From.... Loan Amount £ Term Required Yrs   Mths Mortgage Type Variable Fixed Rate Discounted Capped Any Scheme Select From... Scheme Ref (if known)     Mortgage Repayment Type Capital & Interest Interest Only Select From... Type Of Property House Flat Maisonette Select From... If The Property Is A Flat; How Many Storeys High Is The Block? Council Right To Buy? Yes No Select From... Council Valuation £ Purchase Price Of The Property £ If A Remortgage Or Loan;       Valuation £ Purchase Date Name Of Current Mortgage Lender Current Mortgage Balance £ Current Monthly Mortgage Or Rent Payment £ per month Current Monthly Mortgage Or Rent Arrears Nil 1 to 3 Months 4 to 6 Months Over 6 Months Select From... Maximum Arrears In Last 12 Months Nil 1 to 3 Months 4 to 6 Months Over 6 Months Select From... Details Of Any Adverse Credit (Approx dates & amounts of CCJ's,    Defaults, IVA etc.    or state "NONE") APPLICANT ONE APPLICANT TWO    (If Applicable) Occupation Occupation Are They: Employed Self Employed Unemployed Select From... Are They: Employed Self Employed Unemployed Select From... Annual Income £   Annual Income £ Is Self Certified Income Required?   ie. no proof needed No Yes Select...   Is Self Certified Income Required?   ie. no proof needed No Yes Select... Additional Information (Any other information you wish to be    taken into consideration ) Any missed entries will be highlighted after you click the "SUBMIT FOR QUOTATION" Button Above Use Your Browser Back Button To Return To This Page