It takes 3 to 5 business days to receive confirmation from your financial institution that your previous advance payment cleared your account.

If your previous advance due date was within the past 3 to 5 days (and you have online banking) for your convenience, locate your bank's online services using our
BANK LISTINGS PAGE.  This online bank resource page has listings for all online banks. Simply fax a printed bank statement showing confirmation of your previous advance payment to toll free 1-877-369-6702, OR e-mail the confirmation to [email protected] and put your name in the subject line. We will then be able to process your new cash advance request the same day, without having to wait for report of payment. 


Customer Number

Pin Number

Mother's Maiden Name

Your E-Mail Address

NAME (exactly how it appears on your checks)


(middle name or initial


Due date: Your next pay date.
(up to a maximum of 15 days)


I authorize on the date above, an EFT/ACH debit by AmeriCash Advance LLC  in the amount of: 


Do you currently have an advance with another provider ?      

Enter ANY Information changes

(such as changes in employment, address, phone numbers, bank info)  and/or comments in the box below:

I authorize AmeriCash Advance LLC to deposit $500.00 into my account and to withdraw $625.00 on the date specified above.  I understand and agree it is a cash advance UNTIL MY NEXT NEAREST PAY DATE (up to a maximum of 15 days).

I agree to maintain an adequate balance and keep my account(s) open to allow all ACH/EFT and/or bank drafts to AmeriCash Advance to occur in a timely manner for the scheduled due date. I further agree and confirm that by submitting completed/ signed internet request forms as a matter of convenience, hereby constitutes the same legal and binding document as providing AmeriCash Advance LLC with my personal post dated check, in the amount of the cash advance plus associated fees. If the payment is returned for ANY reason, I agree that I will also pay a $25.00 return fee. I agree that upon submission of my electronic signature, I am not presently involved in, nor contemplating bankruptcy proceedings now or in the future.

I understand, acknowledge, and fully agree this transaction is NOT an installment loan that I can make payments on, but is due in full on the due date above. Furthermore, it is pursuant to the Master Cash Advance Agreement, which has been previously executed and is on file with AmeriCash Advance.

I understand and agree. (Please type your signature)

  (Click to SUBMIT your information for processing)

  (Click to DELETE information from above)



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