Selina Finance | Advice+ Referral form

Your details

Brokerage nameYour nameYour email addressYour fee (up to 3%)

Please note that once submitted, any desired changes to your fee on this case must be communicated via email to your Partner Manager.

Your applicant’s details

Applicant company nameApplicant first nameApplicant last nameApplicant email addressApplicant ageApplicant phone numberApplicant incomeLoan purposeNumber of applicants

Facility information

Facility amount

Security property

Property valueOutstanding mortgageAddress line 1Address line 2CityPostcodeFirst charge holder

Case notes

Optional

Please note applicants must be aged between 25 and 70 years old.
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By submitting this form you confirm the customer has given consent for you to share their personal details with Selina Finance.

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Earn up to 3% Broker Fee

You will be paid on any successful referrals