AmeriCash Advance (banks, credit unions,
and the Federal Reserve) will be closed on October 10, 2005, in
observance of Columbus Day. Customers whose Loan requests are processed on
Friday October 7, 2005 will receive funds in their accounts on
Tuesday October 11, 2005
Even though AmeriCash Advance offices will be closed on Monday October 10, 2005, all Request Forms
may be submitted over the weekend and on the holiday, and will be
processed on Tuesday October 11, 2005
A short term
advance provides the cash needed to meet an immediate short-term
cash flow problem. It is not a solution for longer term financial
problems for which longer term financing may be more appropriate.
You may want to discuss your financial situation with a counseling
service in your community. You will be charged additional fees if
you renew/extend the advance.
Notice: Currently not providing services to residents of
NEW
CUSTOMER ADVANCE APPLICATION - SSL SECURED PAGE
CUSTOMER INFORMATION
The
amount I am requesting for
my first advance.
First Name
Middle
Name
Last Name
Birth
Date (mm/dd/yy)
home phone #
cell
phone #
Mother's maiden name
Your
address (no PO Boxes)
City, State
Zip
RentOwn
/ APT.#
Months at
address
Driver's license #
State Issued
Spouse's Name (if married)
Spouse's
SS#
Your fax #
Select amount currently owed
on other cash advances.
Your email address
work
email (if different)
NAME of
your Employer
ADDRESS
of Employer
City,State,Zip
Employer
main phone #
Your
work phone/ ext.
Length
of employment
Are you paid by direct deposit?
Monthly
net (take home) income
What
are your scheduled pay dates?
If
weekly or bi-weekly, what day?
Your
NEXT TWO pay dates/ AND /
Please
make sure these dates are filled in correctly to reflect your
actual pay
dates so we may complete your application process without delay.
Name
of bank
Bank
phone #
Transit Routing
Number
Bank
Account Number
Bank Routing /Account Numbers
are located on the bottom of your personal check.
UPON APPROVAL,
I authorize AmeriCash Advance LLC to deposit a cash
advance (in the amount that I will be approved for, which I
acknowledge may be less than the amount requested) into my
bank account and to withdraw the approved advance amount plus
the associated fee at the rate of $20 per $100 advanced to me,
on the date specified above. I understand and agree the cash
advance amount received plus fee is due on my NEXT NEAREST PAY
DATE (up to a maximum of 18 days).
I understand I will be contacted by phone at the numbers
provided on this application to confirm my approved cash
advance amount.
Legal/Disclosure Acknowledgement: If
you acknowledge that you have read the disclosures listed in
the Master Agreement, verify by clicking the yes button below
to continue. You may review these documents again by
clicking here :Master
Agreement (disclosures)I
agree that electronic mail, electronic forms, records,
photocopies, and /or facsimile copies of the documents I
submit are valid and enforceable as the original. I
agree that by typing my name as my electronic signature, it is
acknowledged and understood that it constitutes an acceptance
of all terms and conditions of the master cash advance
agreement and is valid and enforceable in accordance with the "Electronic
Signatures in Global and National Commerce Act"
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
americashadvance.com 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 that,
upon approval, this and all future transactions are
made pursuant to the AmeriCash Advance Internet Master Cash
Advance agreement (which will be on file with AmeriCash
Advance) and is NOT an installment
loan that I can make payments on, but is due in full on my
next nearest pay date.
I
have read, understand, and agree to ALL terms, disclosures,
and conditions of the AmeriCash Advance Internet Master Cash
Advance Agreement.
(MUST
SELECT ONE)
By electronically signing this form I acknowledge that all
information provided by me in this application is true and
correct and authorize AmeriCash Advance LLC, its successors,
and assigns, to verify any and all information contained
herein. Furthermore, I authorize AmeriCash Advance to
conduct the EFT transactions and/or bank drafts requested now
and in the future, according to all agreements and disclosures
listed.
TYPE
YOUR NAME
AS YOUR ELECTRONIC SIGNATURE
Type
your Social Security Number
Please
re-type your Social Security # to verify.
Any
additional comments, type here:
For
your records, print a copy of your completed application
BEFORE submitting.
Click
to SUBMIT your information for processing.
After you submit this application, you will then view the
Agreement Signature Page PRINT, SIGN, and FAX with the required
verification items. Once these items are received, only then
will your approval process will begin. The approval process
takes approximately 30 minutes.