Is It a Joint Account?
Select Yes No Not Joint but multiple cards

What type of Card?
Select AA Abbey Accept Alliance & Leicester ASDA Bank of Ireland Direct Bank of Scotland Barclaycard Barclays Black Horse Personal Finance BlackHorse Bradford & Bingley Britannia Building Society Capital One Bank Cheshire Building Society Clydesdale Bank Coventry Cumberland Derbyshire Direct Line Egg First Direct First Trust Bank (NI) Furness Building Society G.E. Money Great Universal Greenwood Personal Credit Halifax HSBC Lloyds TSB Loans4Sure Lombard Direct Marks & Spencer Money Nationwide Building Society NatWest Net Car Northern Bank (NI) Northern Rock Norwich & Peterborough B.Soc. Oakam Penrican Post Office Ltd Provident Personal Credit Real Financial Services Royal Bank of Scotland Sainsbury's Finance Smile Stroud & Swindon Building Society Tesco Personal Finance The Co-operative Bank UCC Ulster Bank Welcome Yorkshire Bank Your Personal Loan Zopa Other... MINT MBNA HFC

Balance Outstanding? (approx)


Did you take PPI?
Yes   Did you claim? Select Yes No Unsure
No

Have you ever been late or missed a payment?
Select Never Once Sometimes Often All the time Not paying at present

When did you open this Account/Agreement?


Did you recall signing new terms and conditions since April 2007?
Yes
No

Have you ever used your card to withdraw cash?
Yes
No

Has your credit limit ever been increased without your explicit consent?
Yes
No

Have you ever been in a payment arrangement or debt plan?
Yes
No

Your Name:


Your Email address:
(If you would like a copy of the test results):


Contact Phone Number: