Short term loan application form

We offer Short Term Loans from £50 to £500 repayable over 15, 20 or 25 weeks.

Check out our rates as a comparison on Lenders Compared.

Please complete our application form and we will get back to you ASAP with an answer.

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• You can read our Debt Advice page here.

Loan Application Form

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Are you in one of the following post codes, please note we can only accept applicants from these post codes. If your answer is 'None of the above' please do not proceed. We cannot service flats unless there is street access to the front door. *

• CH62 1xx
• CH62 4xx
• CH62 5xx
• CH62 8xx
• CH63 2xx, 3xx, 4xx, 5xx, 6xx, 7xx, 8xx, 9xx.
• CH42 1xx ,2xx,3xx
• None of the above – in which case please do not submit the form as we are unable to help

Loan details

Please use the slider to select the loan amount required, this can be any amount from £50 to £500

Selected Value: 50

Loan repayment schedule – 15, 20 or 25 weeks

• 15 weeks
• 20 weeks
• 25 weeks

Personal Details

Name *

First

Last

Date of birth

Email *

Phone *

Address

Town / City

County

Post code

Residential status

• Tenant
• Council tenant
• Owner
• Living with parents
• Other

Time at this address

• Less than 3 months
• 4 – 6 months
• 7- 9 months
• 10-12 months
• 1 to 2 years
• 3 to 4 years
• 4 years or more

Employment status

Monthly income after tax £

Pay frequency

• Weekly
• Fortnightly
• Every 4 weeks
• Last working day of the month
• Another regular day of the month
• Self employed
• Other

Type of employment

• Full time
• Part time
• Temporary
• Self employed
• Unemployed
• Student
• Pensioner
• Disability claimant
• Other

Benefits – If you are in receipt of any benefits please add the amounts below

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Income support

ESA

PIP

Pension

Working tax credit

Child tax credit

Child benefit

DLA

Carers allowance

Are you in receipt of maintenance?

If you are in receipt of maintenance, please add monthly amount below

Monthly outgoings

Please estimate your monthly outgoings

Monthly rent / Mortgage £

Heating: gas / electric / oil £

Please estimate monthly costs for heating and lighting

Water £

Phone and Broadband £

Including mobile and landline

Mobile phone

Monthly cost

Council tax £

Existing loans £

Monthly repayments

Food £

Include take-aways, deliveries etc

Transport £

For car owners include fuel, insurance, servicing. For public transport include trains, buses etc.

Total monthly outgoings £

Calculated automatically

I consent to my data to be used for a credit check and for surveys and marketing *

• Yes

I agree to the terms of the Privacy notice *

• Yes

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Submit

• You can read our Privacy Notice here.
• You can read our Debt Advice page here.