Mortgage Broker Durham - Paul Cowley
Name *

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Last
Address *

Street Address

Address Line 2

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Email
Main Telephone Number *
Please Input your best contact telephone number
Alternative Number *
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Mortgage Quote Required

Please complete below so we can arrange the best quote for your needs.
Mortgage Quote Required *
Please select the mortgage quote required from the drop down box above.
Property Value
Insert the value of the property
Outstanding Mortgage or How much do you wish to borrow if purchase
Insert the existing mortgage value or the amount you need to borrow for the purchase
If Remortgage do you wish to borrow any additional monies
Do you wish to borrow any additional monies for debt consolidation or home improvements
Total Amount of mortgage required
Add existing mortgage plus additional borrowing
Applicant 1 D.O.B *
Please input the first applicants Date of Birth
Applicant 1 Gender *
 Male 
 Female 
Select from the above.
Applicant 1 Employment status
 Employed 
 Self Employed - with 3 years+ account 
 Self Employed - No Accounts 
 Retired 
 Unemployed 
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Have you missed any mortgage payments in the last 12 months
 Yes 
 No 
Have you ever had a CCJ registered against you
 Yes 
 No 
Have you been declared Bankrupt in the last 6 years
 Yes 
 No 
Are you in a DMP or an IVA at present
 DMP 
 IVA 
 None 
Acceptance of future contact *
 I agree 
I have read, understood and accept the Data Protection and Future Relationship Declaration and Privacy Policy. I also agree to my details being held on your database and I understand they may be used for future marketing purposes. I also consent to be contacted by my local mortgage broker by Telephone, Post or Email. I accept the internet is not a secure medium and the privacy of my data cannot be guaranteed if communicated via the internet.