Mersey Mortgage - In-Principle Hire Purchase Application

To see if your case fits, without any obligation, just complete the following form
- it'll only take a couple of minutes.

We will respond to your e-mail address as soon as any information becomes available.

Press Tab to move to each field or Shift Tab to reverse.

Any field marked * is obligatory!	Personal	Details
	Email address: *
	Title:
	Forename(s): *
	Surname: *
	Date of birth: *
	Marital Status:
	Dependents:
	On Voters Roll: *
	Address: *
	Postcode: *
	Time at above address:	Years Months
	Home Telephone: *
	Mobile Phone:
	At your present property, are you:
	Monthly Mortgage or Rent: *
	if Homeowner:
	Estimated Value:
	Mortgage Outstanding:
	Name of Landlord or Building Society:
	Previous Address & Postcode: (if less than 3 years at current address)
	Time at this address:	Years Months
	Banking	Details
	Name: *
	Location: *
	Sort Code: *
	Account Number: *
	Account Opened:
	Employment	Details
	Occupation: *
	Name of Employer, Works Address: *
	Works Postcode: *
	Time with Employer: *	Years Months
	Work Telephone: *
	Gross Income: *	per annum
	Previous Employer, Works Address & Postcode: (If less then 3 years with current employer)
	Other	Details
	Do you have: *
	Cheque Guarantee Card:	Yes No
	Credit Cards:	Yes No
	Store Cards:	Yes No
	Other Loans:	Yes No
If none of the above, then 3 months most recent bank statements will be required
	Enter any other relevant information here: ie. CCJs, arrears etc. *
	Details	of goods
	If a motor vehicle, go to the vehicle detail field. Give full details of the goods, Description, Make, Model, Serial no. etc.
	Price:
	Deposit available:
	Term requested:	months
	Vehicle	Details
	Make of Vehicle:
	Model:
	Body:	3 Door 5 Door Estate Other
	if other:
	Year of Manufacture:
	Registration No:
	Mileage showing:
	Price:
	Deposit available:
	Term requested:	months
	Supplier's	Details
	Supplier's Name, Address & Postcode: *
	Supplier's Telephone: *
	Any Other Details:
	How did you find our web site?:
	if other:

Please check your entries before submitting this form

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Mersey Mortgage - In-Principle Hire Purchase Application
Mersey Mortgage & Loan Services
Last updated: January 6th, 2004