Request an ESIS

Contact Details

Company Name *:

Company Contact

Title *:

Email address *:

First name *:

Telephone number:

Surname *:

Fax number:

Are you directly authorised by the Financial Conduct Authority:

Are you an appointed representative of a network or who is authorised by the FCA:

What level of service has been provided:

What fee have you charged the customer for advising or arranging this mortgage:

Have you charged the customer any other fees in connection with this transaction?:

Are the fees payable up front OR at commencement of the mortgage:

Are any of the fees you charge the customer or the procuration fee you may receive from the Furness Building Society being refunded or rebated to the customer, in any circumstances e.g. if the application does not proceed:

Do any of the fees change if the amount of the mortgage changes:

Are any of the fees you charge the customer or procuration fee you may receive from Furness Building Society being paid to another 3rd party e.g., Network, Mortgage Club or another individual apart from the customer themselves:

ESIS Request

Type of Mortgage *:

Customer name *:

Address Line 1:

Address Line 2:

Town:

County:

Country:

Postcode:

Account Number (if Existing Customer):

Date of Birth (App 1) *:

Date of Birth (App 2) *:

Purchase Type:

Estimated Valuation OR Purchase Price:

Post code of security address:

Repayment Type:

Mortgage Product Code Required *:

(code can be found on the product matrix)

Loan Amount *:

Term *:

Fees

Please indicate how your client wishes to pay associated fees:

Application Fee*

Completion Fee*

CHAPS Fee*

Insurance Fee*

Higher lending charge*

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Request an ESIS

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Contact Details

Company Contact

Principal Address

ESIS Request

Fees

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