Payday Loan Application Form

( Please note: indicates a required field )

Your Personal Details

Title

Select. . . Mr Mrs Miss Ms

First Names

Surname

Date of Birth (dd/mm/yyyy)

Length of UK Residency

Select. . . 0 - 1 Year 1 - 2 Years 2 - 5 Years 5 Years + Since Birth

House Name or Number & Street Address

Town/City

Post Code

Time at Current Address

 Years   Months

Telephone 1

Telephone 2 (optional - mobile or other)

E-mail Address

Confirm E-mail Address (enter it again)

Employment Details

Employer’s Name

Town/City

Telephone

Telephone Extension/Department

Occupation

Time Employed

Select. . . Under 6 Months 6 Months - 1 Year 1 Year - 3 Years 3 Years +

Monthly take-home pay (£)

Select. . . 0 - 699 700 - 999 1000 - 2000 2000 - 3000 3000+

Payment Date

Select. . . Weekly Fortnightly Last Thursday of the month Last Friday of the month Last working day of the month Every 28 days Other

If Other... enter your payment date details

Payment Type

Select. . . BACS Direct into Bank CHAPS Cash-in-Hand Cheque-in-Hand

Do you have any other income paid directly into your bank account

Select. . . Yes No

If Yes... Please give details

Bank Details

Bank Card Held

Select. . . Debit Maestro Switch Solo Visa Electron Cheque Guarantee Card None

Bank Name

Select. . . Abbey AIB Alliance & Leicester Barclays Citi Bank Halifax HSBC Lloyds TSB Nationwide Natwest Royal Bank of Scotland Yorkshire Other

Time with Bank

 Years     Months

Overdraft Limit (£)

Loan Details

Loan Amount Required (£)

Select. . . 80 100 200 300 400 500 600 750

Purpose of Loan

Terms & Conditions

I confirm that the above information is correct and hereby authorize Wage Day Advance or any of its agents.

• To collect by direct debit, electronic or any other means any monies owed under this agreement, from any bank, credit card account, or cheque account, which the customer has supplied details of to Wage Day Advance.
• To contact me at work or visit me at home to discuss my account or application.

Marketing Information

By accepting our terms and conditions you, the applicant, agree that Wage Day Advance and associate companies may solicit by mail, email, or telephone for any further products. Wage Day Advance will retain information provided by you on computer. One of the ways your information will be used is to send you information or phone you about other products or services offered by Wage Day Advance or other carefully selected companies.

I confirm that I accept all of the above

Select... Yes No

IMPORTANT
If, after submitting this application form, you do not receive an e-mail notifying you of our decision, please check your e-mail spam folder or call us on 01535 613001