Enquiry Form

At Home & Capital we are here to help you plan for your retirement. To fully benefit from our services, please complete the following enquiry form.

Please tell us how we can help:

I would like a brochure
I would like a call back about a general enquiry
I would like to receive personal Equity Release advice

About you

About your home

Single enquiry Joint enquiry

1st Applicant	2nd Applicant
Title Mr Mrs Miss Dr Other (Please specify) * First Name * Surname * Age *	Title Mr Mrs Miss Dr Other (Please specify) * First Name * Surname * Age *

Please note: Equity Release is available to homeowners aged 55 and over.
However we are happy to send you information for future reference.

Address	*	Telephone	*
		Email	*
Postcode	*
Where did you hear about us?
			* Mandatory details

It would help us to provide you with personal advice if we have some information about your property

About your home

Estimated property value	£	*
Do you have debt or a mortgage secured against the property?		Please select... Yes No *
If so, how much?	£	*
If there's anything else you’d like to tell us please use the space below
Please tick this box if you do not wish to be added to our database and receive regular information about our products and services. You can be removed at anytime by e-mailing enquiries@homecapital.co.uk.

About your home

Property type		Please select... House Bungalow Flat Other *
Property structure
Estimated property value	£	*
Do you have debt or a mortgage secured against the property?		Please select... Yes No *
If so, how much?	£	*
How many floors are there?
Is the property freehold or leasehold?		Please select... Freehold Leasehold *
How many years are left on the lease?
Is the property a retirement home or sheltered accommodation?		Please select... Retirement Home Sheltered Accommodation Neither *
Is the property ex-government or ex-local authority owned?		Please select... Yes No Don't know *
How much money do you wish to raise through equity release?	£
Please note, you must repay any outstanding debt on the property from the money released
If there's anything else you'd like to tell us please use the space below
Please tick this box if you wish do not to be added to our database and receive regular information about our products and services. You can be removed at anytime by e-mailing enquiries@homecapital.co.uk.