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New customer application

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Step 1 of 6

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Form Type

editform

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Use the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field.

Customer information

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Customer number

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A/C number

Monday ID

Personal information

Title*

First name*

Surname*

Date of birth*

DD slash MM slash YYYY

Contact details

Mobile telephone number*

Email*

Address details

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Find Address

Address*

Enter house number and address City County Postcode Country

Have you lived here for more than 3 years?*

Previous Address

Enter address City County Postcode Country

Residential status*

Do you live in a flat?*

Photographic ID

Do you have Photo ID?*

Proof of I.D.

Drop files here or

Accepted file types: jpg, png, pdf, heic, Max. file size: 512 MB.

Please upload proof of identification. We require an image of your Driving license or Passport. If you don't have one of these, we may except a copy of your birth certificate or an NHS Letter.

Your household

Marital status*

Children under 18*

Employment status

Employment status*

Wage frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly wage amount*

Fortnightly wage amount*

4 weekly wage amount*

Monthly wage amount*

Please upload your most recent wage slip*

Drop files here or

Accepted file types: jpg, png, pdf, heic, Max. file size: 512 MB.

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Calc Weekly wage amount

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Calc Fortnightly wage amount

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Calc 4 Weekly wage amount

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Calc Monthly wage amount

Financial income

Do you receive universal credit?

Yes

Universal credit benefit frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly universal credit benefit amount*

Fortnightly universal credit benefit amount*

4 weekly universal credit benefit amount*

Monthly universal credit benefit amount*

Please upload proof of your UC*

Please upload a screenshot of your UC portal with name, address, and payment amount visible.

Drop files here or

Accepted file types: jpg, png, pdf, heic, Max. file size: 512 MB.

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Calc Weekly universal credit amount

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Calc Fortnightly universal credit amount

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Calc 4 Weekly universal credit amount

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Calc Monthly universal credit amount

Do you receive employment support allowance (ESA)?

Yes

ESA benefit frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly ESA benefit amount*

Fortnightly ESA benefit amount*

4 Weekly ESA benefit amount*

Monthly ESA benefit amount*

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Calc Weekly ESA benefit amount

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Calc Fortnightly ESA benefit amount

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Calc 4 Weekly ESA benefit amount

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Calc Monthly ESA benefit amount

Do you receive job seekers allowance (JSA)?

Yes

JSA benefit frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly JSA benefit amount*

Fortnightly JSA benefit amount*

4 Weekly JSA benefit amount*

Monthly JSA benefit amount*

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Calc Weekly JSA benefit amount

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Calc Fortnightly JSA benefit amount

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Calc 4 Weekly JSA benefit amount

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Calc Monthly JSA benefit amount

Do you receive disability living allowance (DLA)?

Yes

DLA benefit frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly DLA benefit amount*

Fortnightly DLA benefit amount*

4 Weekly DLA benefit amount*

Monthly DLA benefit amount*

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Calc Weekly DLA benefit amount

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Calc Fortnightly DLA benefit amount

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Calc 4 Weekly DLA benefit amount

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Calc Monthly DLA benefit amount

Do you receive child tax credits?

Yes

CTC benefit frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly CTC benefit amount*

Fortnightly CTC benefit amount*

4 Weekly CTC benefit amount*

Monthly CTC benefit amount*

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Calc Weekly CTC benefit amount

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Calc Fortnightly CTC benefit amount

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Calc 4 Weekly CTC benefit amount

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Calc 4 Monthly CTC benefit amount

Do you receive child benefit?

Yes

Child benefit frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Child benefit amount*

Fortnightly Child benefit amount*

4 Weekly Child benefit amount*

Monthly Child benefit amount*

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Calc Weekly Child benefit amount

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Calc Fortnightly Child benefit amount

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Calc 4 Weekly Child benefit amount

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Calc Monthly Child benefit amount

Do you receive income support?

Yes

IS benefit frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly IS benefit amount*

Fortnightly IS benefit amount*

4 Weekly IS benefit amount*

Monthly IS benefit amount*

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Calc Weekly IS benefit amount

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Calc Fortnightly IS benefit amount

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Calc 4 Weekly IS benefit amount

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Calc Monthly IS benefit amount

Do you receive a pension?

Yes

Pension frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Pension amount*

Fortnightly Pension amount*

4 Weekly Pension amount*

Monthly Pension amount*

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Calc Weekly Pension benefit amount

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Calc Fortnightly Pension benefit amount

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Calc 4 Weekly Pension benefit amount

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Calc Monthly Pension benefit amount

Do you receive personal independent payment (PIP)?

Yes

PIP frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly PIP amount*

Fortnightly PIP amount*

4 Weekly PIP amount*

Monthly PIP amount*

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Calc Weekly PIP benefit amount

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Calc Fortnightly PIP benefit amount

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Calc 4 Weekly PIP benefit amount

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Calc Monthly PIP benefit amount

Do you receive carers allowance?

Yes

CA frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly CA amount*

Fortnightly CA amount*

4 Weekly CA amount*

Monthly CA amount*

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Calc Weekly CA benefit amount

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Calc Fortnightly CA benefit amount

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Calc 4 Weekly CA benefit amount

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Calc Monthly CA benefit amount

Do you receive working tax credits?

Yes

WTC frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly WTC amount*

Fortnightly WTC amount*

4 Weekly WTC amount*

Monthly WTC amount*

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Calc Weekly WTC benefit amount

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Calc Fortnightly WTC benefit amount

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Calc 4 Weekly WTC benefit amount

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Calc Monthly WTC benefit amount

Do you receive any other income?

Yes

Other income details*

Other income frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Other income amount*

Fortnightly Other income amount*

4 Weekly Other income amount*

Monthly Other income amount*

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Calc Weekly Other income amount

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Calc Fortnightly Other income amount

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Calc 4 Weekly Other income amount

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Calc Monthly Other income amount

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Proof of income

Please upload 2 documents showing your proof of income

Drop files here or

Accepted file types: jpg, png, pdf, heic, Max. file size: 512 MB.

Financial expenditure

Do you pay rent or a mortgage?

Yes - I pay part or all of this

Rent or mortgage frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Rent or mortgage amount*

Fortnightly Rent or mortgage amount*

4 Weekly Rent or mortgage amount*

Monthly Rent or mortgage amount*

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Calc Weekly Rent or mortgage amount

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Calc Fortnightly Rent or mortgage amount

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Calc 4 Weekly Rent or mortgage amount

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Calc Monthly Rent or mortgage amount

Do you pay council tax?

Yes - I pay part or all of this

Council tax frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Council tax amount*

Fortnightly Council tax amount*

4 Weekly Council tax amount*

Monthly Council tax amount*

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Calc Weekly Council tax amount

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Calc Fortnightly Council tax amount

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Calc 4 Weekly Council tax amount

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Calc Monthly Council tax amount

Do you pay for electricity?

Yes - I pay part or all of this

Electricity frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Electricity amount*

Fortnightly Electricity amount*

4 Weekly Electricity amount*

Monthly Electricity amount*

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Calc Weekly Electricity amount

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Calc Fortnightly Electricity amount

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Calc 4 Weekly Electricity amount

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Calc Monthly Electricity amount

Do you pay for gas?

Yes - I pay part or all of this

Gas frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Gas amount*

Fortnightly Gas amount*

4 Weekly Gas amount*

Monthly Gas amount*

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Calc Weekly Gas amount

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Calc Fortnightly Gas amount

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Calc 4 Weekly Gas amount

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Calc Monthly Gas amount

Do you pay for water?

Yes - I pay part or all of this

Water frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Water amount*

Fortnightly Water amount*

4 Weekly Water amount*

Monthly Water amount*

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Calc Weekly Water amount

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Calc Fortnightly Water amount

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Calc 4 Weekly Water amount

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Calc Monthly Water amount

Do you pay a phone bill?

Yes - I pay part or all of this

Phone bill frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Phone bill amount*

Fortnightly Phone bill amount*

4 Weekly Phone bill amount*

Monthly Phone bill amount*

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Calc Weekly Phone amount

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Calc Fortnightly Phone amount

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Calc 4 Weekly Phone amount

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Calc Monthly Phone amount

Do you pay for food?

Yes - I pay part or all of this

Food bill frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Food bill amount*

Fortnightly Food bill amount*

4 Weekly Food bill amount*

Monthly Food bill amount*

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Calc Weekly Food amount

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Calc Fortnightly Food amount

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Calc 4 Weekly Food amount

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Calc Monthly Food amount

Do you pay for transport (Public or Car Costs)?

Yes - I pay part or all of this

Transport bill frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Transport bill amount*

Fortnightly Transport bill amount*

4 Weekly Transport bill amount*

Monthly Transport bill amount*

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Calc Weekly Transport amount

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Calc Fortnightly Transport amount

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Calc 4 Weekly Transport amount

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Calc Monthly Transport amount

Do you pay for other utilities (Sky, Virgin, etc.)?

Yes - I pay part or all of this

Utilities bill frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Utilities bill amount*

Fortnightly Utilities bill amount*

4 Weekly Utilities bill amount*

Monthly Utilities bill amount*

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Calc Weekly Utilities amount

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Calc Fortnightly Utilities amount

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Calc 4 Weekly Utilities amount

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Calc Monthly Utilities amount

Do you pay for child care?

Yes - I pay part or all of this

Child care bill frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Child care bill amount*

Fortnightly Child care bill amount*

4 Weekly Child care bill amount*

Monthly Child care bill amount*

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Calc Weekly Child care amount

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Calc Fortnightly Child care amount

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Calc 4 Weekly Child care amount

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Calc Monthly Child care amount

Do you have other loan repayments?

To companies that are not Mersey Loans.

Yes - I pay part or all of this

Other loan bill frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Other loan bill amount*

Fortnightly Other loan bill amount*

4 Weekly Other loan bill amount*

Monthly Other loan bill amount*

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Calc Weekly Other loans amount

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Calc Fortnightly Other loans amount

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Calc 4 Weekly Other loans amount

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Calc Monthly Other loans amount

Any other expenditure?

Yes - I pay part or all of this

Other expenditure frequency*

Weekly

Fortnightly

4 Weekly

Monthly

Weekly Other expenditure amount*

Fortnightly Other expenditure amount*

4 Weekly Other expenditure amount*

Monthly Other expenditure amount*

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Calc Weekly Other expenditure amount

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Calc Fortnightly Other expenditure amount

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Calc 4 Weekly Other expenditure amount

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Calc Monthly Other expenditure amount

Affordability conclusion

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Total income after tax

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Total outgoings

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Monthly declared remainder

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25% additional outgoings

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Hidden - Shared Figure calculates 25%

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Weekly affordability conclusion

Other financial information

Do you have any County Court Judgements?*

Have you ever been Bankrupt?*

Have you ever taken out an IVA or Debt Relief Order?*

Have you ever taken out a Debt Management Plan?*

Household income

Has there been a decrease to household income in in the last 3 Months?*

Do you expect your household income to reduce in the next 12 Months?*

Loan information

Select a loan amount*

Payment Period - 25 Weeks

Weekly Repayment - £6

Total to Repay - £150

APR - 468.2%

Payment Period - 25 Weeks

Weekly Repayment - £12

Total to Repay - £300

APR - 468.2%

Online banking

Do you have online banking?*

Who do you Bank with?*

Bank name*

Through the application process, we will perform a credit check on you, this is done using Experian.

Your loan

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Amount you’re looking to borrow*

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Loan Purpose?*

Receiving funds/loan

How would you like to receive funds? - Cash/Bank transfer*

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Sort Code

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Account Number

How would you like to pay?

Repayment

Please select how you would like to pay*

Please select collection frequency*

What is your actual payment date*

DD slash MM slash YYYY

Card details

Continuous Payment Authority

Name as it appears on your card*

Last 4 digits of your debit card you wish to make payments from*

Expiry date month*

Expiry date year*

Mersey Loans

Have you had a loan with MerseyLoans in the past?*

How did you hear about us?*

Consent*

Consent. I agree. By ticking this box you give us permission to add you to our marketing list. This is so you can receive the latest updates about our services, special offers and more.*

Confirmation: We take your privacy very seriously! We make sure that the data you provide to us is secure and not misused. You can view our privacy notice here: https://merseyloans.co.uk/privacy-notice/

Consent*

Consent. I agree. By Ticking this box you agree to the use of your data as stated in our Privacy Policy.*

See Privacy Notice

Through the application process, we will perform a credit check on you, this is done using Experian. You can see how the data is used here: https://www. https://www.experian.co.uk/legal-information/terms-and-conditions.html

Further consent*

Further consent. I agree. By Ticking this box you agree to the use of your data as stated in our Privacy Policy.*

See Privacy Notice

Permission*

Permission. I agree. By ticking the box below you give permission for one of our agents to visit you at your home to discuss your application.*

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Referred by

Proof of ID

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Proof of ID

Proof of income

Proof of outgoings

Receivable funds

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Loan amount

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Cleared amount

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Rebate

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You will receive

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Notes

WARNING: Late repayment can cause you serious money problems. For help, go to moneyadviceservice.org.uk

£200.00 payable over 25 Weeks at £12.00 per week. Rate of interest 50% fixed; Representative 468.2% APR. Total amount payable is £300.00. Compare the price of Home collected and other cash loans at www.lenderscompared.org.uk