How much do you need to borrow?

£

How long do you need to repay the loan?

What will you use the loan for?

Living Expenses
Debt Consolidation
Vehicle Repair
Home Improvement
Medical Treatment
Other

What's your title?

Mr.
Miss.
Mrs.
Ms.
Mx.

What's your full name?

What's your date of birth?

What's your marital status

Single
Married
Living Together
Separated
Divorced
Widowed
Other

Do you have any dependant children?

None
1
2
3
4
5+

What's your email address?

What's your contact details?

What's your home address?

What's your residential status?

Home Owner
Private Tenant
Council Tenant
Living with Parents
Other

How long have you lived at your home address?

Whats your employment status?

Self Employed
Full-Time Employment
Part-Time Employment
Temporary Employment
Pension
Disability Benefits
Benefits

Whats your employers name?

How long have you worked there

Which industry do you work in?

None
Construction / Manufacturing
Military
Health
Banking / Insurance
Education
Civil Service
Supermarket / Retail
Utility / Telecom
Hotel / Restaurant / Leisure
Office Based
Not Office Based

Whats your work phone number

How much is your net monthly income?

£
.00

How often are you paid?

Weekly
Bi-Weekly
Four Weekly
Monthly
Last Monday of Month
Last Tuesday of Month
Last Wednesday of Month
Last Thursday of Month
Last Friday of Month
Last Working Day of Month
Specific Date

When are you next paid?

When is your following pay date?

Are you paid directly to your bank account?

Yes, to UK Account
Yes, to non-UK account.
No

What are your estimated monthly outgoings?

£
£
£
£
£
£

Where do you want the money?

Which bank card do you have?

None
Switch / Maestro
Visa Debit
Visa Electron
MasterCard Debit

Do you use online banking?

Yes
No

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

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IMPORTANT: By clicking the "Apply Now" button, you confirm you have provided accurate financial information and considered potential future income and outgoings in determining your ability to repay. You also confirm that you agree to the Clockwork Loans Terms & Conditions and you understand and agree to the use of your personal data in accordance with the Privacy Policy including a possible credit check carried out by a credit reference agency.