QUICK LOAN APPLICATION FORM

Hidden

DATE(Required)

Phone(Required)

Email(Required)

FACILITY DETAILS

TYPE(Required)

AMOUNT (£25K MINIMUM)(Required)

Please enter a number from 25000 to 1500000.

Please enter an amount greater than £25K and not greater than £1.5M

TERM(Required)

LOAN REASON(Required)

DESCRIBE YOUR REQUIREMENTS FURTHER(Required)

CLIENT DETAILS

BUSINESS NAME(Required)

TRADING ADDRESS(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

COMPANY REG NO

DIRECTORS / PROPRIETORS

DIRECTOR 1

NAME(Required)

ADDRESS(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

DATE OF BIRTH(Required)

DIRECTOR 2

NAME

ADDRESS

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

DATE OF BIRTH

SECURITY

ADDRESS(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

VALUE OF PROPERTY(Required)

VALUE OF EXISTING MORTGAGES OR CHARGES(Required)

OWNER 1

NAME OF OWNER(Required)

DATE OF BIRTH(Required)

OWNER 2

NAME OF OWNER

DATE OF BIRTH

AUTHORISATION(Required)

I/We confirm that the information provided in this proposal form is true, accurate, and complete. I/We understand that the information that I/we have submitted will be used in order to assess the suitability to be granted a secure business loan and I/we give our consent to the information that I/we have provided being shared with third parties for this purpose. I/We understand and agree that I/we may be asked to provide additional information about ourselves, key principles, relevant third parties, or the business to assist with progressing our application. I/We further agree that the information that I/we have provided may be submitted to credit reference agencies by the nominated secured commercial loan provider in order that a credit check may be conducted. I/We expressly acknowledge that authorising searches to be conducted and references obtained does not entitle us or persons named to see such searches or references and agree that I/we will direct any request for copies of searches or references to the relevant originating party and not to the named referring broker. I/We understand that the business may be refused a business loan facility as a result of the searches and references obtained and agree that I/we shall not seek to hold the named referrer liable for such refusal nor shall I/we seek to bring any claim against the named referrer for any loss or damage suffered by me as a result of such refusal. I/We understand that information which I/we provide or which is collected about me or persons names may be retained on file or stored electronically by the named referrer in accordance with the provisions of the EU General Data Protection Regulation (GDPR). I/we agree to being contacted about our business regarding other related products and services which may be of interest, such as various Asset Based Lending solutions & Business Consultancy Services. I/We acknowledge I/we have provided this information to Rocque Associates LTD T/A Your Money Works who is acting as broker and NOT a lender.

APPLICANTS NAME(Required)

DATE (DD/MM/YYYY)(Required)

Name

This field is for validation purposes and should be left unchanged.