PIS Application Form
Introducer Details
Note these details will be used to send you updates
Name
Email Address
Telephone No.
Business Details
Business Name
Trading Name
Company Registration No.
Business Address
(inc full postcode)
Trading Address
(inc full postcode)
Company Legal Status
(select one)
Limited Company
LLP
Sole Trader
Trading Since
Industry Sector
(select one)
Agriculture
Manufacturing of Non Food
Retail Non Food
Construction
Motor Trades
Telecommunications
Health
Online Business
Transport and Storage
Hotel / B&B
Professional and Business Services
Wholesale
IT Services
Restaurants / Pubs / Cafe
Manufacturing of Food
Retail Food
Other
Please specify industry
Financial Details
Annual Turnover
£
Monthly Turnover
£
Card Sales Turnover (If Any)
£
Yearly Profit
%
Does the business have an overdraft facility?
No
Yes (if yes what is their limit)
What is your overdraft limit?
£
Does your business have any other loans/MCA?
No
Yes (if yes, specify amount)
Amount
£
Funding Details
Loan Amount
£
Use of Funds
(select one)
Inventory / Stock Purchase
Equipment / Machinery
Business Interruption
Expansion / Renovation
Working capital
Payroll
Business Debt Consolidation
Cash Flow
Quarterly VAT Repayment
Other
Please specify use of funds
Contact Details
First Name
Middle Name
Last Name
Contact Email Address
Contact Telephone No
Date of Birth
Home Address
(inc full postcode)
Stay more than 3 years
Are you a home owner?
Past Address
Yes
No
Past Address
(if less than 3 years at current address)
Residence Recent Valuation
£
Any Mortgage
£
Position
(select one)
Owner
Director
Managing Director
CEO
Shareholder
Ownership
(if less than 51% please include details of other directors / owners)
%
Other directors
Owners | Shareholders
+ Add Another Director
Date
VAT Registration
VAT Registered
Comments
Submit Application
Director / Owner / Shareholder __INDEX_LABEL__
Remove
First Name
Middle Name
Last Name
Contact Email Address
Contact Telephone No
Date of Birth
Home Address
(inc full postcode)
Stay more than 3 years
Are you a home owner?
Yes
No
Past Address
Residence Recent Valuation
£
Any Mortgage
£
Position
(select one)
Owner
Director
Managing Director
CEO
Shareholder
Ownership
%