Please fill out the enquiry below

Your details - Please enter your details below

*Title:

--- Mr. Mrs. Miss Ms. Dr.  

*First Name:

*Last Name:

*Date of Birth:

Address:

*Home phone:

 
please include alternative phone number below:
Work phone number; or mobile number.

*Work phone:

* Mobile:

*Email:

Newsletter:

--select-- no yes  

Mortgage Details

*Mortgage amount:

£ (e.g. 92500)

*Property value:

£ (e.g. 125000)

*Mortgage Type:

--- select --- Re-mortgage Purchase Buy-to-let  

*Have you found a property?

--- select --- Yes No Re-mortgage  

*First Time Buyer?

Yes   No      

*Self Certified:

Yes   No        
(self certified means unable to provide proof of income)

*Poor Credit:

Yes   No        
(any missed payments on loans, credit cards or mortgage arrears or County Court Judgments?)

*When do you need your mortgage?

-- please select -- Within 1 month. Within 2 months. Within 3 months or more.  

*Term of mortgage:

years     (1 - 50)

Notes:

The personal information you provide will be used and stored in accordance with the Data Protection Act 1998. You have a right to access all the personal information that The Mortgage Clinic holds about yourself. To receive this we must receive a written request including a £10.00 fee made payable to The Mortgage Clinic.

Please check your details before submitting.