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<% step1=Request.Form("step") if step1=0 then step1=1 end if select Case step1 case 1 %> "> Your residential status? * select homeowner Tenant   Who would you like the cheque made payable to? * Loan amount? *   Main purpose of the loan? please select Consolidation Car Christmas Business Home Improvements Clear Existing Credit Other Loan period * years 1 Yrs 2 Yrs 3 Yrs 4 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs 9 Yrs 10 Yrs 11 Yrs 12 Yrs 13 Yrs 14 Yrs 15 Yrs 16 Yrs 17 Yrs 18 Yrs 19 Yrs 20 Yrs 21 Yrs 22 Yrs 23 Yrs 24 Yrs 25 Yrs   Current Debt level, if any:* Do you have adverse credit? (if yes, we can still help)* yes no   Your title Dr Hon Miss Mr Mrs Ms Rev First Name *   Middle Name Sur Name*   Date of birth? * DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 Address*   Town/City * Postcode*   County* Email*       Phone number *   Mobile number * Best time to call * morning afternoon evening   When to call please select... today Tomorrow 2 days time 3 days time 4 days time 5 days time 6 days time Property Postcode:*   Property name/ number: Your Maiden Name   Mothers maiden Name* Years with your bank? select 0 1 2 3 4 5 6 7 8 9 >10   Children under 18? select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Employment status? * please select... Disabled Employed FT Employed PT Househusband Housewife Retired Self - Employed Student Unemployed   Time in your present job? * years 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50   months 0 1 2 3 4 5 6 7 8 9 10 11 12 What is your occupation? *   Annual income before tax? * Your marital status* please select... Divorced Living with partner Married Separated Single Widow Widower Other   Is property jointly owned? yes no    Your Partner - If you are married or cohabiting   If you are applying for a loan and you are married or living with a partner, we will need to ask questions about your partner       Your title Dr Hon Miss Mr Mrs Ms Rev   Middle name First name *   Surname * Your maiden name *   Date of birth? * DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 Children under 18? select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20   Your marital status? please select... Divorced Living with partner Married Separated Single Widow Widower Other Home phone (+ area code) *   Mobile phone number* Email address   Best time to call morning afternoon evening Years with your bank? select 0 1 2 3 4 5 6 7 8 9 >10   Time in your present job? * years 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50   months 0 1 2 3 4 5 6 7 8 9 10 11 12 Annual income before tax? *   Your employment status?* please select... Disabled Employed FT Employed PT Househusband Housewife Retired Self - Employed Student Unemployed Mothers maiden name   Lives at same address? * Yes No     Address House Number * Street * Town/City * Postcode *   County Additional income? * yes no       If self-employed, what proof of income do you have * Accounts Tax Returns Self-certification   If so what is this annually? * Source of this income? *   <% case 2 %> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> "> ">       Who is your present mortgage company? * What is the total balance outstanding on your mortgage * Monthly repayment? *   What is the term remaining on your mortgage? * years 0 1 2 3 4 5 6 7 8 9 10 15 20 25 30 35 40 45 50 months 0 1 2 3 4 5 6 7 8 9 10 11 12 What type of mortgage do you have? * please select... Deferred Endowment Flexible Interest only Isa Low start Pension Repayment   Have you had arrears on your mortgage in the last 12 months? * yes no       Mandatory if you answered "yes" to the above question: What are the present arrears on your mortgage? * What is the highest your arrears have been in the last 12 months? * Have you made your last 3 repayments on time? * yes no Do you have any other loans secured against your property? * yes no If yes, which company was this loan with? What is the total amount you owe this company?     Your House   The value of the property    £ *   Number of bedrooms * select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Approximate year built? 12 13 14 15 16 17 18 19 20 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99   When did you purchase it? (year if month/day unknown) * / dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / mm 01 02 03 04 05 06 07 08 09 10 11 12 / yyyy 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 What was the original purchase price? £   Property type? * please select... Bungalow - detached Bungalow - semi-detached Bungalow - terraced Care Home Detached Detached - Link End of Terrace Flat Maisonette Mid Terrace Other Chalet/Dormer Semi Detached Terraced Townhouse If a flat, how many floors in the building? 0 1 2 3 4 5 6 7 8 9 >10   What is the construction? * please select... Bricks & mortar Concrete-panels Concrete-poured Mobile home Steel frame Stone Timber framed Has property been owned by council? yes no   Time at current address? * Less than 3 yrs More than 3 yrs Ex-council Owners (only complete this section if property is ex-council) Did you purchase as sitting tenant? yes no As you answered "Yes" to the above, please answer the following: What did the council value the property at for purchase? What discount did you receive from the council?