Miller Gardner

Questionnaire - Credit Card Agreement and Late Payment Charges


Full Name
Full Postal Address
Email
Joint Applicant Name (if any)
Telephone (home)
Telephone (work)
Telephone (mobile)
Joint Applicant Full Postal Address
National Insurance Number (party 1)
National Insurance Number (party 2)
Date of Birth (party 1)
Date of Birth (party 2)
Date of Consumer Credit Card Agreement (if known)
Agreement Number (if known)
Presesnt Balance outstanding
Have you incurred any late payment fees?
Has your credit limit been increased since the original card was issued?
Original credit limit
Present Credit limit