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California Residents - Notice of Separate Account California law requires that you be informed that if you are married, then you may apply for a separate account. Personal Information First Name. Semi-monthly - Paid same 2 days every month. By electronically signing below, you and we agree to the Arbitration Agreement and the Notice-of-Grievance Agreement, each of which is set forth above. After you obtain this transaction, you will have no more than 2 payday transactions outstanding with us or any other creditor. Attempting to obtain a credit transaction by providing false information, including but not limited to the use of false or altered documents and the use of another person's identity other than your own Identity Theftis fraudulent and, in some cases, punishable by law.

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PayDay Loan Application By signing "Consent for Credit Information", I/We understand that I/We give RepubliCash the right to use this document for the purpose of obtaining any and all info which may be pertinent to securing a pay day advance loan, (hereinafter "loan") I/we understand that information may be requested from the following. LOAN APPLICATION FORM OL NV (5/13) Co-Applicant (must sign below) Checking Account Information I have been receiving income without a break of 31 days or more for: less than 3 months 3 to 6 months 6 to 12 months 1 to 3 years more than 3 years Payday Loan with a Check Payday Loan without a Check Title Loan. Created Date. payday loan reform act Application is hereby made to the Director of Financial Institutions for a license to engage in the business under the .

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Knowingly making a false statement on a credit application is a crime. If the below "I agree" box is checked, you authorize us to electronically debit the above referenced bank account for your loan payments.

Yes, I would like to receive SMS text alerts providing status updates on my loan, information about my account, and marketing promotional offers on my mobile phone. If the person or entity against whom a Claim is asserted declines to arbitrate the Claim or if a court or arbitrator determines that the above Arbitration Agreement is unenforceable, then you and we agree that neither you nor we may commence, join, or be joined to any judicial action as either an individual litigant or the member of a class that arises from or relates to a Claim until the claimant has provided the other party written notice of the asserted Claim and afforded the other party a reasonable period after the giving of the written notice to take corrective action.

If applicable law provides a time period which must elapse before certain action can be taken, then that time period will be deemed reasonable for the purpose of the preceding sentence. By clicking the "I Agree" button below, you authorize us to verify the accuracy of the information contained in this Credit Application by, among other actions, submitting your application to a consumer reporting agency, calling your employer to confirm employment, calling your residence to confirm a working home phone number, and obtaining your bank account information.

If you obtain one or more Transactions from us, you further authorize us to service your Transactions by obtaining information about your location from the contact persons you have listed. By clicking the "I Agree" button below, I represent and warrant that I am not a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or a dependent of such a member.

Furthermore, by clicking the "I Agree" button below, you also agree to all the terms of both the Arbitration Agreement and the Notice-of-Grievance Agreement set forth above.

Finally, you represent and warrant that all the information contained in this Credit Application is true and correct, that you are not currently a debtor in any bankruptcy proceeding, and that you do not intend to file a bankruptcy petition under any chapter of the U.

Bankruptcy Code either during the term of a Transaction or within the 90 day period following your repayment of a Transaction. Claim means any claim, dispute, or controversy arising from or relating to this Agreement, this Transaction, any other agreement or transaction that you and we have ever entered into or completed, or any other conduct or dealing between you and us.

A court or arbitrator interpreting the scope of this Arbitration Agreement should broadly construe the meaning of Claim so as to give effect to your and our intention to arbitrate any and all claims, disputes, or controversies that may arise between you and us.

Consistent with this broad construction, Claim includes but is not limited to each of the claims, disputes, or controversies listed below. A Claim includes any dispute or controversy regarding the scope, validity, or enforceability of this Arbitration Agreement. For example, a Claim includes any assertion by you or us that this Arbitration Agreement is unenforceable because applicable usury, lending, or consumer protection laws render the underlying Transaction void or unenforceable.

A Claim also includes any assertion by you or us that this Arbitration Agreement is unenforceable because it lacks fairness or mutuality of obligations, conflicts with bankruptcy or other federal laws, improperly limits your or our remedies for the other's violation of laws, or unduly restricts your or our access to the court system.

Finally, a Claim includes any assertion by you or us that this Arbitration Agreement is unenforceable because you or we did not receive notice of or understand its provisions, you or we need to discover the filing fees or administrative costs associated with commencing an arbitration proceeding, or you or we believe the arbitration firm or the arbitrator will be unfair or biased.

A Claim includes any claim that you assert against a person or entity related to us - including our parent company, affiliated companies, directors, officers, employees, agents, and representatives - and any claim that we assert against a person or entity related to you. For the purpose of this Arbitration Agreement, references to we , our , and us and references to you and your include such related persons or entities.

You and we agree that these related persons and entities may elect to arbitrate any Claim asserted against them even though they have not signed this Arbitration Agreement. A Claim includes any statutory, tort, contractual, or equitable i.

For example, a Claim includes any claim arising under the following: A Claim includes but is not limited to any claim based on your or our conduct before you and we consummated this Transaction. For example, a Claim includes any dispute or controversy regarding our advertising, application processing, or underwriting practices, our communication of credit decisions, or our provision of cost-of-credit or other consumer protection disclosures. A Claim includes any request for monetary damages or equitable remedies, whether such request is asserted as a claim, counterclaim, or cross-claim.

Mandatory Arbitration Upon Election. Subject to your right to reject arbitration explained on page 1 of this Agreement and subject to the small claims court exception explained below , you and we agree to arbitrate any Claim if the person or entity against whom a Claim is asserted elects to arbitrate the Claim. Consequently, if the person or entity against whom a Claim is asserted elects to arbitrate the Claim, then neither you nor we may file or maintain a lawsuit in any court except a small claims court and neither you nor we may join or participate in a class action, act as a class representative or a private attorney general, or consolidate a Claim with the claims of others.

A person or entity against whom a Claim is asserted may elect to arbitrate the Claim by providing oral or written notice to the person asserting the Claim i. Such notice need not follow any particular format but must reasonably inform the claimant that arbitration has been elected. For example, if you or we file a lawsuit against the other, then the other provides sufficient notice if the other orally informs the claimant that the other elects to arbitrate the Claim or if the other files a pleading i.

Small Claims Court Exception. You and we may ask a small claims court to decide a Claim so long as no party to the small claims court lawsuit seeks to certify a class, consolidate the claims of multiple persons, or recover damages beyond the jurisdiction of the small claims court. If you file a small claims court lawsuit against us, then we lose the right to elect arbitration of your Claim but not of other persons' Claims. In contrast, if we file a small claims court lawsuit against you, then you retain the right to elect arbitration of our Claim.

The AAA will normally apply its Consumer Arbitration Rules then in effect to a Claim but may apply other types of procedural rules - such as the AAA's Commercial Arbitration Rules then in effect - if a party to the arbitration proceeding demonstrates that the application of such other procedural rules is appropriate.

No matter what the arbitration firm's procedural rules provide, you and we agree that the arbitrator must issue a written decision and may award any type of remedy - including punitive damages and equitable relief - that a court or jury could award if the Claim were litigated.

You and we also agree that an arbitration firm may not arbitrate a Claim as a class action or otherwise consolidate the Claims of multiple persons. You may request a copy of the AAA's Consumer Arbitration Rules and other procedural rules at the toll-free phone number or URL universal resource locator identified above.

If you object to the AAA as the arbitration firm, then the parties may agree to select a local arbitrator who is a retired judge or a registered arbitrator in good standing with an arbitration firm, provided that such local arbitrator must enforce all the terms of this arbitration agreement, including the class-action waiver. The parties may not select a local arbitrator who refuses to enforce this arbitration agreement, including the class action waiver, because you and we waive any right to arbitrate a Claim on a class-action, representative-action, or consolidated basis.

When attempting to contact AAA or another arbitration firm, please recognize that phone numbers and URLs change frequently; you may need to update the contact information provided above with your own research. We will pay any costs of the arbitration. An arbitration proceeding will be held within 10 miles of your address contained in this Agreement unless you consent to another location after an arbitrable dispute occurs.

An arbitration proceeding will be conducted by a neutral arbitrator who was not and is not currently being paid by us and who has no financial interest in a party to the arbitration. The arbitration proceeding will provide you with all the substantive rights that you would have if your Claim were asserted in a court proceeding and will not limit any other claim or defense you have concerning the Claim. You and we acknowledge that this Transaction involves interstate commerce.

Accordingly, you and we agree that both the procedural and the substantive provisions of the Federal Arbitration Act, 9 USC , govern the enforcement, interpretation, and performance of this Arbitration Agreement. Any court with jurisdiction may enforce this Arbitration Agreement. Additionally, any court with jurisdiction may enforce an arbitration decision rendered under this Arbitration Agreement if that arbitration decision has been properly registered as a judgment.

Survival; Binding Effect; Severability. You and we retain the right to invoke this Arbitration Agreement and to compel the arbitration of Claims even after your and our respective obligations under this Agreement have been completed, defaulted, rescinded, or discharged in bankruptcy. This Arbitration Agreement binds the heirs, successors, and assigns - including any bankruptcy trustee - of both you and us.

Finally, if a court or arbitrator determines that any part of this Arbitration Agreement is unenforceable, then you and we agree that the court or arbitrator must fully enforce the remaining provisions that have not been invalidated. By electronically signing below, you and we agree to the Arbitration Agreement and the Notice-of-Grievance Agreement, each of which is set forth above.

I have read, understand, and accept the terms of the Arbitration Agreement. Please read this information carefully and, for future reference, either print a copy of this document or retain this information electronically. I have read and understand and accept the terms of the Consent for Electronic Records. I agree that Check 'n Go may share my personal financial information with non-affiliated companies, as described in Check 'n Go's privacy policy.

For example, if Check 'n Go cannot provide me the loan or other financial product I have requested, then Check 'n Go may share my information with an outside company that offers a similar product that may meet my needs. Attempting to obtain a credit transaction by providing false information, including but not limited to the use of false or altered documents and the use of another person's identity other than your own Identity Theft , is fraudulent and, in some cases, punishable by law.

Check 'n Go Online reserves the right to report any and all information obtained in connection with a verified fraud attempt to local, state, or federal authorities including the Internet Crime Complaint Center, an FBI-NW3C partnership, for possible investigation and prosecution. Notice of Furnishing Negative Information We may report information about your account to credit bureaus.

Late payments, missed payments, or other defaults on your account may be reflected in your credit report. California Residents - Notice of Separate Account California law requires that you be informed that if you are married, then you may apply for a separate account. By hitting the continue button, I agree the information supplied in the loan application is accurate and I have read and agree to the terms and conditions above.

By submitting the application, Check 'n Go may offer you other available products or services. Many, but not all, banks and other depository financial institutions participate in an electronic funds transfer EFT debit network that is compatible with AccelaCashSM. If your bank participates in a compatible EFT debit network and you submit your loan application anytime except between the hours of 7: ET the daily period when Check 'n Go Online performs website maintenance , then your bank will generally make the loan proceeds available to you immediately following our loan disbursement.

Your bank may initially display the loan proceeds as a "pending transaction" prior to moving the proceeds to your bank account's available or posted balance. The loan application form clearly lists the two parties to the loan and the parts responsible for the relevant loan terms and conditions that both parties need to comply with.

The specifics of the loan application form vary from bank to bank, but basically there is a booklet telling you all the requirements to help you fill out the bank loan application form correctly.

What Is Loan Application Form The loan application form clearly lists the two parties to the loan and the parts responsible for the relevant loan terms and conditions that both parties need to comply with.

The loan application form will clearly state the loan repayment terms. For example, repayment methods: The loan application template can handle all types of repayment conditions. You can also negate the payment or change the terms and conditions of the loan application form by adding clauses. Your consent is not required to obtain any product or service from ACE and you may opt-out at any time by unselecting such boxes above.

ACE is the largest owner and operator of check cashing stores in the United States and the second largest owner and operator of short-term consumer loan stores in the United States. Loan Amount Select Loan Amount.

Personal Information First Name. Number or Suite if applicable. E-mail Address Email Address already exists. Password Password must be between 6 to 14 characters in length and have at least 1 number.

Do you rent or own? Select Own Rent Other. Are you currently filing for or considering bankruptcy?