Online Submission Form In order to ensure prompt payment of your procuration fees, you must submit a completed form for each mortgage application that you submit to the lender. Please note: Please do not complete this form to amend a submission form already sent to us. Seller Details PMR Number* Adviser Name*   Company Name*   Company Address*       Postcode* Customer Details Name of Customer(s)*   First Line of Mortgaged Property Address*   Postcode* Purchase Price of property (£)* Mortgage Amount (£)* Date submitted to lender* (dd/mm/yyyy) Lender/Product Details Please select a Lender and then select appropriate Product Category and Product Type Lender Details* Select... Abbey BM Solutions Chorley Building Society Coventry Building Society Furness Building Society Halifax Leeds Building Society Nationwide NatWest Northern Rock Paragon Precise Mortgages Scottish Widows Bank Skipton Building Society The Mortgage Works Woolwich Product Category* Select... Mainstream Self Cert Buy to Let Sub-prime 100%/100%+ Offset/Flexible Mortgages Lifetime/Equity Release Equity Release   Type of purchase* Select... Purchase Remortgage FTB *Denotes a required field

For more information please contact our Mortgage Club Helpdesk on:
T: 08450 615000
F: 08450 615001
E: pmc@paymentshield.co.uk
Lines are open: 9am - 5.15pm, Monday to Friday

© Paymentshield Limited, 2011

Paymentshield Limited (registered number 02728936) is a company registered in England and Wales at Paymentshield House, Southport Business Park, Wight Moss Way, Southport, PR8 4HQ. Telephone calls may be recorded for security purposes and monitored under our quality control procedures

Paymentshield Limited is authorised and regulated by the Financial Services Authority (FSA) under registration No. 312708. See www.fsa.gov.uk/register for further details