FORM # 1 CUSTOMER INFORMATION SHEET
Please READ, SIGN, and FAX back to: 1-877-520-4308 (Toll-Free) If you have any questions contact our Customer Service E-mail Address at cashadvance@cashadvanceusa.com, if you do not have one call at 1-866-840-0440 or 1-800-780-9369(Toll-Free) Name E-Mail Address Physical Address City Mailing Address (If different from above) City Home Phone Number ( ) Social Security Number Place of Employment Department Fax Phone Number ( ) Driver's License # / State ID# State Sex M F Zip Code Date of Birth State Zip Code
Occupation
Date of Next Payday
How Often do you get paid?
Work Phone Number ( ) Direct deposit into checking? yes no
weekly bi-weekly monthly other: Checking account number Bank Name Bank phone number How did you hear about us? ( ) Personal References (Relatives that you see at least once a week) Name Relationship Phone number ( ) Name Relationship Phone number ( ) Name Relationship Phone number ( ) Name Relationship Phone number ( )
I understand Cash Advance USA's check collecting policy and authorize electronic credits And debits to my account in accordance with that policy. Signed ___________________________________ Date ___ _______ _______
FORM # 2 CASH ADVANCE REQUIREMENTS AND INFORMATION for $200 Loan
Please READ, COMPLETE, SIGN, and FAX back to: 1-877-520-4308 (Toll-Free) If you have any questions contact our Customer Service E-mail Address at cashadvance@cashadvanceusa.com, if you do not have one call at 1-866-840-0440 (Toll-Free)
To receive a payday advance you need to meet these simple requirements: You must have a net income (take home pay) of at least $200 per week. Along With this document you must send us the following information. A completed Customer Information Sheet (Form #1 or Online Application) A completed Requirement Information Sheet (Form #2) A completed Loan Agreement (Form #3) A copy of your signed personal check made out to Cash Advance USA for $250.00. DO NOT VOID IT! A copy of one form of state-issued picture identification (driver’s license, state ID, etc) A copy of your last paycheck stub/detail. A copy of your most recent bank statement (this statement must for a 30-day period and dated within 30 days of the day you apply) All forms must be signed If we do note receive the above information with your application your loan will not be processed! Your loan is due on the due date! THIS IS A 15-DAY LOAN and you can renew it by simply e-mailing our office 3 business days before your loan is due. If your payment is returned to us for non-sufficient funds your account will be turned over to our Collections department. Your borrowing privileges will be TERMINATED with our company. Information on you and your account will be turned over to Scan and Telecheck services and your Check Writing privileges will be TERMINATED! Your information will be turned over to the credit bureau’s delinquent account division. THERE WILL BE A $50.00 RETURNED CHECK FEE ON EACH NON-SUFFICIENT ITEM RETURNED. By signing this document you authorize CASH ADVANCE USA to effect ACH debit and credit entries into the bank account submitted. In the event that your payments are returned unpaid for any reason, you authorize CASH ADVANCE USA to effect ACH debit entries for the amounts of the checks or debit entries submitted with this agreement plus any accrued late fees or applicable late fees or applicable NSF charges. DO NOT SIGN THIS DOCUMENT OR RECEIVE A PAYDAY LOAN BY PHONE UNLESS YOU UNDERSTAND OUR PROGRAM AND PROCEDURES FULLY. PLEASE CONSULT A CUSTOMER SERVICE REPRESENTATIVE TO ANSWER ANY QUESTIONS YOU MIGHT HAVE. On my due date I would like the following amount debited from my checking account: (choose only one) ______ $250.00 (your entire balance) ______ $ 50.00 (fee for EACH 15 day extension you request before paying off full amount of $250.00) ______ Please specify number of extensions you wish before paying off full amount of $250.00. If you wish to change your payment selection please call a customer service representative 3 business days before you loan due date. SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE FULLY READ AND TOTALLY UNDERSTAND ALL INFORMATION ON THIS DOCUMENT. __________________________________ Borrower’s Signature
________________________________________
_______________________________ Date
______________________________________
Borrower’s Name
Social Security Number
FORM # 3 LOAN AGREEMENT for $200 Loan
(COMBINATION PROMISSARY NOTE, DEFERRED PRESENTMENT AGREEMENT AND TRUTH IN LENDING STATEMENT)
Please READ, COMPLETE, SIGN, and FAX back to: 1-877-520-4308 (Toll-Free) If you have any questions contact our Customer Service E-mail Address at cashadvance@cashadvanceusa.com, if you do not have one call at 1-866-840-0440 (Toll-Free) Name_____________________________________ E-mail_____________________________________________ Address_______________________________________City_____________________State_________ Zip_________ SSN#_____________________ Date of Birth___________ Employer_______________________________________ Home # ___________________Work #__________________ Fax #_________________ How often do you get paid? 1-Reference Name: ____________________________ Telephone: _________________ Weekly Bi-Weekly 2-Reference Name: ____________________________ Telephone: _________________ Semi-Monthly Monthly Direct Deposit to checking? Yes No Date of Next 3 Paydays__________________________________________ TRUTH IN LENDING ACT DISCLOSURES
ANNUAL % RATE
The cost of your credit as a yearly rate.
FINANCE CHARGE
Amount Financed
Total of Payments
The amount you will have paid after you have made all payments as scheduled
The dollar amount the credit will cost The amount of credit provided to you. you.
__608.33__%
$
50
. $ 250
$ 200
$
250
.
Payment Schedule: One payment in the amount of
due on _____________ ______ _________.
Month Day Year
See the terms below for additional information about non-payment and default.
ITEMIZATION OF THE AMOUNT FINANCED OF $200.00 (1) AMOUNT PAID TO YOU DIRECTLY (2) PREPAID FINANCE CHARGE
Initial
$200.00 $ 50.00
I UNDERSTAND CASH ADVANCE USA’S CHECK COLLECTION
POLICY, POLICY AND AUTHORIZE ELECTRONIC DEBITS FROM MY ACCOUNT.
Initial
BANK:_____________________________________ RTNG #__________________ACCT #: _______________________
Customer waives presentment and consents to telephonic verification of my bank account balance and agrees to NSF charges in the event of insufficient funds therein on the date and time of the telephonic verification; however only one NSF charge may be made. I, The presenter and the customer shown above here attest that the check being presented for this delayed deposit agreement is drawn from a legal, open and active account. The check is not altered, forged, stolen or obtained through fraudulent or illegal means and is not negotiated without the proper authority or represent the proceeds of illegal activity.
Initial
As states above "I", "Me", or "My" means all Borrowers and "You" means the Lender-Creditor named above PROMISSORY NOTE-NEGOTIABLE PAPER FOR VALUE RECEIVED, the undersigned (whether one or more) jointly, severally solidarity, promise to pay to the order the Lender stated above the Total of payments shown above until the full amount of this note shall be paid. In the event that any installment under this note is not paid is full within (10) days following its scheduled due date, a Delinquency charge will be assessed equal to five (5%) percent of the unpaid installment amount or $15.00, whichever is less. The parties hereto further bind themselves to pay reasonable fees of any attorney at law who may be employed to recover the amount of this note, or any part hereof, in principal and interest, or to protect the interest of Lender or to compromise or take any other action with required thereto, which fees are hereby fixed at twenty-five (50%) percent of the amount of the unpaid debt. Upon the occurrence of one or more of the following events of default (1) failure to make any monthly payments when due: (2) Failure to perform any obligation under any Security Agreement securing this note: (3) borrower defaults under any other credit extension with Lender; (4) Borrower should die, or become insolvent, or apply for bankruptcy or other relief from creditors; (5) Lender reasonably believes itself to be insecure in the repayment of this note. Lender may, at its option, declare the entire unpaid balance of this Note to be due immediately and payable without notice or demand. Borrower agrees that the origination fee, if any, included in the prepaid finance charge disclosed above, is fully earned and is not subject to rebate upon prepayment or acceleration of this note, and not considered interest. All parties hereto severally waive presentment for payment, demand, protest, and notice of protest and non-payment, and all pleas of division and discussion and agree that the payment of this Note may be extended by Lender from time to time, one or more times, without notice, hereby binding themselves jointly, severally, and solidarity, unconditionally waiving all pleas of discussion and division, and as original makers and promissory for the payment hereof in principal, interest, cost and attorney's fees. Lender may at any time release any of the parties hereto, in whole or in part, from their obligations hereunder without in any manner affecting or impairing the rights against all other parties hereto not so release. All parties hereto severally consent and agree that any and all collateral securing this note may be exchanged or surrendered or otherwise dealt with from time to time without notice to or from any party hereto and without in any manner releasing or altering the obligations of the parties hereto under this Note. No delay on the part of the Lender in exercising any power or right hereunder shall operate as a waiver of any such power of right nor shall any single or partial exercise of any power or right hereunder preclude other or future exercise thereof or the exercise of any other power of right hereunder. As used herein the term "parties hereto" shall be deemed to include not only the Borrower hereof but also any guarantor or guarantors. All parties hereto further severally agree that this Note evidences and sets forth their agreement with the holder hereof and that no modifications hereof shall be binding unless in writing and signed by the parties hereto. I (we) further acknowledge receipt of a completed copy of this Truth-in-Lending Disclosure Statement Promissory Note and Security Agreement.
CUSTOMER’S SIGNATURE______________________________________
DATE: ________________
FORM # 4 WIRE TRANSFER FORM (optional)
Please READ, COMPLETE, SIGN, and FAX back to: 1-877-520-4308 (Toll-Free) If you have any questions contact us at cashadvance@cashadvanceusa.com , or call at 1-866-840-0440 (Toll-Free) I, ___________________________________ authorize Cash Advance USA to Credit my checking account for the amount of my loan minus a service fee of $15.00. The service fee will be deducted from the amount of my loan at the time of the wire transfer. (see chart below) Amount of Loan Wire Fee Amount of Credit to Bank Account $100 $200 $300 $400 $500 $15.00 $15.00 $15.00 $15.00 $15.00 $85.00 $185.00 $285.00 $385.00 $485.00
This fee does not in any way change the amount of your loan, your Annual Percentage Rate or amount owed to Cash Advance USA for repayment of your loan. Your Bank Wire will be made once all of your loan forms and documentation has been received and approved at our Lending Facility. Any Bank Wire requests made after 12:00 PM Eastern will be batched the following day. Please check with your bank regarding their Wiring Policies. Your bank may charge an Incoming Wiring Fee not associated with our Outgoing Fee of $15.00. Your bank may also post the wires instantly as they come in, or may hold them until the end of the day. We are not responsible for the wire once it is batched from our bank. CUSTOMER’S SIGNATURE: ______________________________________ DATE: ________________
***VERY IMPORTANT***
You MUST contact your bank and ask them for Wiring Instructions for a Credit to your checking Account. Please fill out this form exactly. If a wire is rejected due to an error on this form the $15.00 Wire Service Charge will not be refunded
FIRST BANK NAME: FIRST BANK ROUTING NUMBER:
FURTHER CREDIT TO (Second Bank Name, not all banks will have this, mainly for smaller banks):
SECOND BANK ROUTING NUMBER (not all banks will have this, mainly for smaller banks):
YOUR NAME:
YOUR BANK ACCOUNT NUMBER:
BANK’S TELEPHONE NUMBER YOU CALLED TO RECEIVE THIS INFORMATION:
NAME OF THE PERSON YOU SPOKE TO AT THE BANK: