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Form
Name*:
Mr
Ms
Mrs
Your title
First Name:
Please Enter Name
Surname:
Please Enter Surname
Address Line 1*:
Please Enter Adress
Your house/flat name/number and street
Address Line 2:
The remainder of your address
County:
The county you live in
Postcode*:
Please Enter Postcode
Your postcode
Home Phone:
Your home telephone number
Mobile Phone:
Your mobile telephone number
Email:
Your email address
Bank Accounts:
0
1
2
3
4
5
(How many personal bank accounts do you have with penalty charges?)
Click here for important information regarding current account claims
Credit Cards:
0
1
2
3
4
5
(How many credit cards do you have with penalty charges?)
PPI Policies:
0
1
2
3
4
5
How many Payment Protection policies do you wish to claim on?
Mortgage Accounts:
0
1
2
3
4
5
How many mortgage accounts do you wish to claim on?
Are your debts getting on top of you?
Yes
No
would you like us to contact you about debt?
Yes
No
What is the best time to contact you?
-- Select time --
9:00 am
10:00 am
11:00 am
12:00 pm
1:00 pm
2:00 pm
3:00 pm
4:00 pm
5:00 pm
6:00 pm
How is your salary paid?
Weekly
Monthly
Other
-- Select payday of the week --
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
-- Select payday of the month --
1
2
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Comments:
Details marked with a * must be completed. For assistance, E-mail:
info@bankcharging.co.uk
Copyright i-sm@rt Customer Services Limited 2007
Authorisation Number CRM2506
Regulated by the Ministry of Justice in respect of regulated claims management activities details available and recorded at:
www.claimsregulation.gov.uk
