Easy Access 4 u - Mortgage Questionnaire

Please be so kind as to fill out the below mortgage questionnaire and application for a mortgage.

joint application sole

Title:

surname:

First names:

Date of birth:

Daytime telephone number:
Evening telephone number:
Mobile number:
Best time to contact:
Email address:
How much would you like to borrow?
What is the current value of your property?
Do you want to:
Do You Need To Self-Certify Your Income?	yes no
Have You Had Any Of The Following:	Had A CCJ or Default Registered Against You? Missed Any Payments On Your Mortgage Or Secured Loan? Been Declared Bankrupt Or Had An IVA?
Additional comments:

I/We would like to be contacted by telephone to discuss my/our mortgage needs.

Mortgage Questionairre and Application for a Mortgage