G AND A DRAPERS

APPLICATION FORM

Please complete the form below & one of our advisers will contact you.

To speak to an Adviser telephone:

01992 577761

	Amount of Loan	Amount Repayable	Payment Per Week	Payment Per Month	Please tick the amount you wish to borrow
	£500	£700	£35.00	£140.00*
	£400	£560	£28.00	£112.00
	£300	£420	£21.00	£84.00
	£200	£280	£14.00	£56.00
	£100	£140	£7.00	£28.00
	£50	£70	£3.50	£14.00
APR 481.4% (weekly payments) APR 305.6% (monthly payments) *or £100 pm if payments endorsed with a cheque guarantee card APR 187.4%

PERSONAL DETAILS:
Title: First Names: Surname:
Property No: Street: Town:
County: Post Code:
Tel No (Home): Tel No (Mobile):
E-mail Address:
Date of Birth: How long in residence: years months
Are you a: Are you living with:

If you have resided at your present address for less than 3 years please enter details of your previous address
Property No: Street: Town:
County: Post Code:
Were you a: Were you living with:

EMPLOYMENT DETAILS:
Job Title: Company:
Property No: Street: Town:
Post Code: Tel No: Ext No: E-mail:
Time with employer: years months Net pay per: Amount:
Next Pay Date: Regular pay day or date: Pay Frequency:

Do you have a bank account: Do you have a cheque guarantee card:
How long have you had your present bank account for? Are you currently or have you ever been with a debt manager?
Have you ever been declared bankrupt? Are you entered into or have you ever entered into an IVA agreement?
Have you any other credit commitments (loans, credit cards, etc)? *
IF THE ANSWER IS 'YES*', PLEASE GIVE FURTHER DETAILS IN THE FURTHER COMMENTS AREA BELOW

FURTHER COMMENTS:

BY TICKING THIS BOX:

I confirm that all the information submitted to you in this form is correct and that
I agree a creditor making a credit reference and fraud prevention Agency search may be recorded by the Agency concerned and shared with other creditors and the creditor may disclose to such agencies how you conduct your account
If you default or are suspected of fraud that other lenders may use this information about you and others with whom you are financially linked for credit assessment, debt tracing, fraud and money laundering prevention
I also agree that this application may be forwarded to another broker or agency to be determined by yourselves in the interest of the customer

G & A Drapers, 4th Floor, Old Bank Chambers, 291 High Street, Epping, Essex, CM16 4DA