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The information collected within this form will be used solely for the purposes of providing background information when contacting you

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BROOMHEADS

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Mortgage Enquiry Form

This form is for UK residents ONLY, if you are not UK resident please do not complete this form.

Please give us as much detail as possible to assist us in dealing with your enquiry and press the SUBMIT button

TITLE 1st Applicant TITLE 2nd Applicant  
SURNAME
 		 SURNAME
 
FORENAMES
 		 FORENAMES
 
ADDRESS
 
 
 
 

Postcode


 

 ADDRESS
 
 
 
 

Postcode


 
HOW LONG AT ABOVE ADDRESS?
 		 HOW LONG AT ABOVE ADDRESS?
 
PREVIOUS ADDRESS 

(if less than 3 years)
 
 

Postcode


 

 PREVIOUS ADDRESS 

(if less than 3 years)
 
 

Postcode


 
WORK TEL. NO. WORK TEL. NO.
HOME TEL. NO.

MOBILE TEL. NO.

HOME TEL. NO.

MOBILE TEL. NO.

EMAIL ADDRESS EMAIL ADDRESS
DATE OF BIRTH DATE OF BIRTH
SMOKER SMOKER
OCCUPATION OCCUPATION
EMP. STATUS EMP.STATUS
LENGTH OF EMPLOYMENT LENGTH OF EMPLOYMENT
PREVIOUS EMPLOYMENT IF LESS THAN 2 YEARS PREVIOUS EMPLOYMENT IF LESS THAN 2 YEARS
BASIC SALARY OR NET PROFIT BASIC SALARY OR NET PROFIT
BONUS E.T.C. 

(state guaranteed, regular) 

BONUS E.T.C. 

(state guaranteed, regular) 

  Property & Mortgage Details  

MORTGAGE/LOAN AMOUNT REQUIRED PURCHASE PRICE OR VALUE OF PROPERTY BEING MORTGAGED
PROPERTY & LOAN TYPE

FIRST TIME BUYER 

OWN PROPERTY TO BE SOLD

 

EXPECTED PRICE

 
DEPOSIT AMOUNT OR % (if any) EXISTING LENDER
EXISTING MORTGAGE AMOUNT MORTGAGE TYPE
REMAINING TERM EXISTING VALUE
If a Business please give full details

  Existing Endowment/Life/Pension policies  

COMPANY TYPE PREMIUM SUM ASSURED TERM START DATE

  

DETAILS OF ANY UNPAID DEBTS, LOANS, CREDIT CARD BALANCES, OR ADVERSE CREDIT SUCH AS COUNTY COURT JUDGEMENTS OR DEFAULTS
 
NOTES;- 

I/We expressly consent to being contacted without prior notice or arrangements by using the contact details I/we have provided on the form and further consent that such contact may be in relation to (a) my/our mortgage arrangements and/or (b) other product and services  

 FOR CONFIDENTIALITY REASONS PLEASE  PRINT OUT AND POST YOUR FORM TO US AT BROOMHEADS. FREEPOST. BLACKPOOL. FY1 3BR

Your home may be repossessed if you do not keep up repayments on your mortgage

We do not charge a fee for mortgage advice however a fee paying option is available. Our typical fee is 1% of the mortgage.