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About your Business

Do you have a different trading style?
Do you trade at a different address to above?

Please provide details of all directors, shareholders and Persons of Significant Control

About your Debtors and Turnover

Please provide details of your 3 biggest debtors




Please let us know the following. 

About your Creditors & Liabilities

Does the bank have a debenture or floating charge?
Please provide the following where applicable:
Crown Creditors
Inland Revenue/PAYE & NI
Customs & Excise/VAT
Please provide details of any arrangements you have in place with Crown Creditors
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Additional Information

Do you currently factor?
Have you ever factored?


Have any of the Principals been involved (officer/shareholder) in a Company which has been, or is likely to be subject to the appointment of an Insolvency Practitioner?
Have any of the Principals ever been declared bankrupt, or entered into arrangements with creditors, or are there any judgements for debt outstanding against them?
Is there any receiving order in bankruptcy, compulsory winding up order, or any arrangements with creditors, or is the company in receipt of any notices in terms of sections 652/653 of the Companies Act 1985?
If you answered yes to any of the above, please provide details: 
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Declaration & Data Protection Act

I/We hereby declare that the information given in this application is correct and to the best of my knowledge and that no information has been witheld.


We reserve the right to make one or more searches with credit reference/fraud prevention agencies, who may keep a record of the search and may share that information with other businesses.

We may also make enquiries about the principal officers/directors with credit reference/fraud prevention agencies; a footprint will be left on their credit files(s).

In terms of the Data Protection Act I / We hereby authorise you to obtain credit searches on Me / The Company and any of its Directors and you may at anytime hold such information on file. We also hereby give permission to disclose such information on file to other Finance Companies who may approach you for a reference. We further acknowledge that the information gathered will then be used in considering this application

Please Sign & Date

Thanks for submitting!

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