New Customer Application


Please complete the application form below. Provide as much information as possible, this will speed up the processing of your application * Indicates a required field.
Your Personal Details
Title*
First name*
Surname*
Address 1*
Address 2
Town*
County
Post Code*
Home Owner / Tenant*	Home Owner Tenant
Home Tel No*
Mobile Tel No
Personal Email*
Date of Birth*
N.I. Number (eg AA999999A)*
Mothers Maiden Name*
Amount Requested (£80-£500)*
How did you hear about us?*
Employment Details
Employer Name*
Address 1*
Address 2
Town*
County
Post Code*
Work Tel No
Work Email*
Occupation*
Time With Employer - Years*
Time With Employer - Months*
Employment Status
Your Employment Status*	Full Time Part Time Self Employed
How is your salary paid?*
If other please state salary payment method
Pay Frequency*
Week Day Paid
Day of Month Paid
Other (state frequency and dates)
Net Salary (after all deductions)*
Marketing Information
By accepting our terms and conditions you, the applicant, agree that Rapid Cash may contact you by post, e-mail, or telephone for any further products. Rapid Cash will keep information provided by you on computer, see our Privacy statement for details on our website. One of the ways your information will be used is to send you information or phone you about other products or services offered by Rapid Cash If you do not wish to receive such mailings or calls please tick this box