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Application Form

If you would like to apply for practice finance then please complete the following form.

If you have any questions please call us on 01543 473 070

Please note, for us to respond to your enquiry promptly the parts labelled in red are required.

Your Name (required)

Practice / Company Name (required)

Your Email (required)

Your Contact Number

Amount Required

Your Message

Alternatively you can download and print out our Finance Application Form which has been created as an Acrobat PDF file. When completed you can post the application form to us at the following address:

The Smithy, Woodgate Stables,
Crawley Lane, Kings Bromley,
Burton Upon Trent
DE13 7JF
Telephone:- 01543 473 070

Or scan and email the application form to:

** Credit Reference Authority:

This statement explains how we use your personal and business information in pursuit of your credit application.
References to ‘we’ and ‘our’ are references to Practice Finance Solutions and our underwriters.
We will conduct searches at credit reference agencies. The searches will be conducted on you, your home address (which may include your spouse, partner and or all of those individuals registered at your home address) your business address, and your fellow partners and/or directors and shareholders. Our searches will be added to your credit reference records which, in turn, may be seen by other organisations when you apply for future credit. We may also check with fraud prevention agencies to prevent or detect fraud.
Please be sure that any information you disclose has the authority of all those individuals who are likely to be affected by our searches.
By agreeing to proceed with the searches associated to your application, you confirm that you have the acceptance of all partners, directors and shareholders.
Information held by credit reference agencies is available to you upon request. You will need to apply in writing. A fee may be charged.