Apply for a Payday Loan in Just Four Minutes Welcome! We only ask the information we need from you on this one page. There are no "hidden" screens or page-after-page of boxes to fill in. It takes the average person just four minutes to complete this application. Warning: It is important to fill out this form accurately. Knowingly making a false statement on a credit application is a crime. Apply in Four Minutes or Less The average time it takes to complete this application is less than 4 minutes when you have the following items ready: Your most recent pay stub. Your most recent bank account statement. Your personal check. Tip: When finished typing an answer, use your keyboard's TAB key (instead of your mouse) to move to the next question. Your information is secure with us. Learn more. About You Average time to complete this step: About 1 minute. First Name MI Last Name Date of Birth       mm/dd/yy E-mail Address E-mail Address (Confirm) Type your E-mail address. Retype your E-mail address. Street Address City State Zip Select AK AL AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Your Home Phone # Cell Phone # ( )   - ( )   - Fax # Contact Phone # ( )   - ( )   - Where we can send a you fax, only if needed. Where we can contact you right away if there is an issue processing your application. Social Security # Social Security # (Confirm)   -     -       -     -     Type your Social Security # Retype your Social Security # About Your Job and References Average time to complete this step: About 1 minute. Company Name Company Phone # ( )   - Name of company where you work. The company's main number. Your Job Title Date Hired   mm/dd/yy Your Work Number Ext.   Shift Hours ( )   -   Your phone number at your company, including your extension.   Ex.: 9 am to 5 pm Supervisor's Full Name Supervisor's Phone # Ext. ( )   - Reference 1 Name Reference's Phone # Relation to You ( )   - Select Parent Sibling Aunt Uncle Child Grandparent In-Law Friend Reference 2 Name Reference's Phone # Relation to You ( )   - Select Parent Sibling Aunt Uncle Child Grandparent In-Law Friend About Your Pay Average time to complete this step: About 2 minutes. My main source of income is: Select Employment Benefits My gross pay (or my benefits) per month is: $     I am paid: Select Every Week Every Other Week Twice Per Month Once Per Month on every: Select Monday Tuesday Wednesday Thursday Friday on: Select Monday Tuesday Wednesday Thursday Friday and my last paydate was: Please check your paystub for this information. 08/24/2010 08/31/2010 08/23/2010 08/30/2010 08/29/2010 09/05/2010 08/28/2010 09/04/2010 08/27/2010 09/03/2010 I am paid . . .     . . . every other week on the same weekday.   on: Select Monday Tuesday Wednesday Thursday Friday   and my last paydate was: Please check your paystub for this information. 08/24/2010 08/31/2010 08/23/2010 08/30/2010 08/29/2010 09/05/2010 08/28/2010 09/04/2010 08/27/2010 09/03/2010   . . . based on the date.   First, I am paid on the: Select 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st   Then, I am paid again on the: Select 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st Last Day   . . . on the same weekday but only twice a month.   On the: Select First and Third Second and Fourth Select Monday Tuesday Wednesday Thursday Friday I am paid . . .     . . . on a specific day.   Every: Select 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st Last Day   . . . during a specific week on a specific day.   On the Select First Second Third Fourth Select Monday Tuesday Wednesday Thursday Friday When I am paid, my paycheck is deposited via Direct Deposit into my bank account:   Yes No My bank account is a: Select Checking Account Savings Account ABA Routing # Bank Account # Type your ABA Routing # Type your Bank Account # ABA Routing # (Confirm) Bank Account # (Confirm) Retype your ABA Routing # Retype your Bank Account # Bank's Name Finish Please review the Terms of this agreement: Arbitration of All Disputes: You and we agree that any and all claims, disputes or controversies between you and us, any claim by either of us against the other (or the employees, officers, directors, agents, or assigns of the other) and any claim arising from or relating to your application for this loan, regarding this loan or any other loan you previously, now or may later obtain from us, this Note, this agreement to arbitrate all disputes, your agreement not to bring, join or participate in class actions, regarding collection of the loan, alleging fraud or misrepresentation, whether under the common law or pursuant to federal or state statute or regulation, including disputes as to the matters subject to arbitration, or otherwise, shall be resolved by binding individual (and not joint) arbitration by and under the code of Procedure of the National Arbitration Forum ("NAF") in effect at the time the claim is filed. This agreement to arbitrate all disputes shall apply no matter by whom or against whom the claim is filed. Rules and forms of the NAF may be obtained and all claims shall be filed at any NAF office, on the World Wide Web at www.arb-forum.com, by telephone at 800-474-2371, or at "National Arbitration Forum, P.O. Box 50191, Minneapolis, Minnesota 55405." Your arbitration fees may be waived by the NAF in the event you cannot afford to pay them. "The cost of any participatory, documentary or telephone hearing, if one is held at your or our request, will be paid for solely by us as provided in the NAF Rules and, if a participatory hearing is requested, it will take place at a location near your residence." This arbitration agreement is made pursuant to a transaction involving interstate commerce. It shall be governed by the Federal Arbitration Act, 9 U.S.C. Sections 1-16. Judgment upon the award may be entered by any party in any court having jurisdiction. NOTICE: YOU AND WE WOULD HAVE HAD A RIGHT OR OPPORTUNITY TO LITIGATE DISPUTES THROUGH A COURT AND HAVE A JUDGE OR JURY DECIDE THE DISPUTES BUT HAVE AGREED INSTEAD TO RESOLVE DISPUTES THROUGH BINDING ARBITRATION. Agreement Not To Bring, Join Or Participate In Class Actions: To the extent permitted by law, you agree that you will not bring, join or participate in any class action as to any claim, dispute or controversy you may have against us, our employees, officers, directors, and assigns. You agree to the entry of injunctive relief to stop such a lawsuit or to remove you as a participant in the suit. You agree to pay the attorney's fees and court costs we incur in seeking such relief. This agreement does not constitute a waiver of any of your rights and remedies to pursue a claim individually and not as a class action in binding arbitration as provided above. Please click here to print the terms of agreement. If you agree to the terms, choose "I Agree":   I Agree I Do Not Agree To continue, please click the "Submit My Complete Application" button below. OPEN 24 HOURS 7 DAYS A WEEK Loans are not available to residents of Georgia, West Virginia, and Ohio. * We only require that you fax information when we are unable to verify your employment or banking information through our system.

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