* First name:

* Surname:

 Date of Birth:

Mobile Phone Number:

Home/Work Phone Number:

* E-mail Address:

House Number:

Postcode:

Step 2 - Refund Calculation

Do you owe more than £2500?

Do you have more than 9 months left to pay?

Did you borrow less than £25,000?

Was it borrowed before April 2007?

Do you pay back more than £120 per month?