Mortgage Intermediary Census

Personal Details

Your personal information will remain completely confidential and will not be released to any other organisation or used to market services to you. They will be retained only for the purposes of contacting you regarding bona fide market research or to notify you of winning a prize.

Please provide your name and email address and a keyword below together with a hint that will assist you in recalling your keyword. The keyword will be used to validate your email address in the future. When entering your email address please ensure that it is accurate.


Firstname
Surname
Email Address
Keyword
Keyword hint (eg. "Mother's maiden name" or "pet's name")

May we have your permission to contact you to seek your views and opinions on other relevant issues from time to time?

	Yes
	No

If you have received a communication from us with a code, please enter it here

Please complete the entire survey to ensure your entry into the draw to win one of the following:

1^st prize - Toshiba 42 inch LCD HD 1080p Digital TV
2^nd prize - Bronze Experience Gift Pack from Red Letter Days
3^rd prize - Wine Buyers' Choice 12 x 75cl Bottles

No purchase necessary. No cash or credit alternatives will be given.

Please Note : all prizes must be claimed within 6 months.

If you encounter any problems in completing the survey, please call NMG on 01780 753 270 and ask for Gareth Tarrant (Mortgage Intermediary Census Helpdesk).