1. Your contact details

Title:
 Date of Birth:
 /    
First Name:
 Middle Name:
 Last Name:
Email Address:
 Password:
 Retype Password:

2. Your income & payday loan details

Building Name:

 Building Number:
Street:

 Flat Number:
Postal Town:
 Postal Code:
 County:
Time at This Address:
 Rent or Own:
 Loan Amount:
Best Time to Call:
 Home Phone:
 Mobile Phone:

3. Employment Info & Acceptance of
Terms

  Employer Name:
  
  Employer Position:
  
  Employer Phone:
  		 Extension:
  Employment Date:
    /    
Source of Income:
 Are you paid into your bank account?:
Salary Each Period:
 Pay Frequency:
Bank Account Number:
 Sort Number:

I have read and accept Kesef Limited's Pre-Contract Information.
I have read and agree to the Website Privacy Policy set forth by Kesef Limited.

Please tick the box if you don't want to be informed by telephone, post or email of selected products and services available from us and other carefully chosen companies.

Important - Your Personal Information:

Credit decisions and also the Prevention of Fraud and Money Laundering

We may use credit reference and fraud prevention agencies to help us make decisions. A short guide to what we do and how both we and credit reference and fraud prevention agencies will use your information is detailed in the section called:

A condensed guide to the use of your personal information by ourselves and at Credit Reference and Fraud Prevention Agencies.

If you would like to read the full details of how your data may be used please visit our website at http://www.countrywidepayday.co.uk or eMail us at: support@countrywidepayday.co.uk.

The information we collect is used by us to manage your account and to make collections; it is also used to contact consumers for marketing purposes; it is disclosed by us when legally required to do so at the request of government authorities conducting an investigation; we also use it to verify or enforce compliance with the policies governing our web site and applicable laws or to protect against misuse or unauthorised use of our web site.

By ticking the box, you are confirming your agreement to proceed and you are accepting that we may each use your information in this way.