Apply Now - New Customer Advance Application

Complete The Following Form

Aplicación española

First Name Middle Name Last Name Birth Date (mm/dd/yy) Home Phone Cell Phone Mother's Maiden Name Address (no PO Boxes) City State Select AL AK CA CT DE DC FL HI ID IN IL IA KY LA ME MD MA MS MN MO MT NE NH NV NJ NM NY ND OH OK OR RI SC SD TN TX UT VA VT WV WI WY  Zip Housing Own    Rent    Apartment Monthly Housing Payment $ Fax Number of Other Advance(s) & Amount(s) Owed Select One 0 1 2 3 4 4+ Select Amount $0/ nothing under $100 $100-$200 $200-300 $300-$400 $400-$500 $500 + Email Work Email (if different)   Employer Name Employer Address   City State Select AL AK 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    Zip    Employer Main Phone Work phone    Ext.   I would like to be enrolled in the Instant Cash Card Program   Select Yes No     If Yes, please confirm your mailing address Are you paid by direct deposit?   Select Yes No Monthly net(take home) income   What are your scheduled pay dates?   Select One Weekly Bi-weekly (every other week) Twice per month Monthly (once per month) If weekly or bi-weekly, what day?   Select One Mon Tues Wed Thurs Fri Your next two pay dates   Month 1 2 3 4 5 6 7 8 9 10 11 12 Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 And Month 1 2 3 4 5 6 7 8 9 10 11 12 Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Please make sure the above dates are selected correctly to reflect your actual paydates so we may complete your application process without delay. Bank Routing/Account Numbers are located at the bottom of your personal check. Click here for a sample check. Name of Bank Bank Phone   Transit Routing Number Bank Account Number   Account Type Select One Checking Savings Request Loan Amount Advance Amount Requested $300 advance $400 advance $500 advance $600 advance $700 advance $800 advance $900 advance $1000 advance $1100 advance $1200 advance $1300 advance $1400 advance $1500 advance $1600 advance $1700 advance $1800 advance $1900 advance $2000 advance Due Date Your next pay date (up to a maximum 15 days) UPON APPROVAL , I authorize National Cash Lenders 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 or $25 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 15 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 National Cash Lenders to occur in a timely manner for the scheduled due date. I further agree and confirm that by submitting completed/ signed nationalcashlenders.com internet request forms as a matter of convenience, hereby constitutes the same legal and binding document as providing National Cash Lenders 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 $30.00 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 National Cash Lenders Internet Master Cash Advance agreement (which will be on file with National Cash Lenders) 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 National Cash Lenders Internet Master Cash Advance Agreement.   Select One YES I AGREE NO I DO NOT AGREE  (MUST Select One BEFORE CONTINUE)   By electronically signing this form I acknowledge that all information provided by me in this application is true and correct and authorize National Cash Lenders LLC, its successors, and assigns, to verify any and all information contained herein. Furthermore, I authorize National Cash Lenders 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 confirm your Social Security Number Referred by: (Needed to receive their referral bonus)       Any additional comments, type here:   After you submit this application, you will be forwarded to the Agreement Signature Page. Please PRINT, SIGN and FAX or EMAIL it with the required verification items. Once these items are received, only then will your approval process begin. The approval process takes approximately 30 minutes. PLEASE SUBMIT YOUR RECENT ONLINE BANK TRANSACTION HISTORY FOR THE LAST 60 DAYS, IF YOU DO NOT HAVE ONLINE BANKING WE WILL ACCEPT YOUR MOST RECENT 30 DAY BANK HISTORY. YOUR LOAN HAS A MUCH HIGHER PROBABILITY OF BEING APPROVED WITH SUBMITTED CURRENT ONLINE BANK TRANSACTION HISTORY For your records, please print a copy of your completed application before submitting. Click to SUBMIT your information for processing.     Notice: Failure to pay loan as agreed will be reported to all agency's listed below, but not limited to; LexisNexis LexisNexis® (www.lexisnexis.com) is a leading provider of information and business solutions to professionals in a variety of industries—legal, risk management, corporate, government, law enforcement, accounting and academic. A member of Reed Elsevier PLC, the company does business with professionals in 100 countries with 13,000 employees worldwide. Building on the 30-year LexisNexis tradition as a trusted provider and custodian of quality information, the LexisNexis® Risk & Information Analytics Group leverages cutting-edge technology, unique data and advanced scoring analytics to provide total solutions for client needs. Our solutions are designed to serve the risk information industry, which includes professionals and organizations such as law enforcement, government agencies, financial services firms, collection agencies, insurance and health care providers, hiring managers and others. MicroBilt Corporation MicroBilt Corporation, is the single source and preferred provider of decision critical information that responsibly assists businesses in reducing risk and managing their business. MicroBilt provides online access to consumer and commercial credit bureau data with automated decisioning and collection services. With its PRBC® Consumer Report with the FICO® Expansion Score, MicroBilt is the leading provider of alternative credit data to businesses that want to offer credit and other financial services to the approximately 110 million underserved and underbanked consumers in the United States. Teletrack Teletrack™ provides lenders and businesses with the actionable intelligence they need to make smart decisions. Businesses access our consumer data for risk mitigation, identity verification, fraud detection, and skip-tracing. CoreLogic CoreLogic® receives information from a variety of sources. Our databases contain unique consumer information that isn't available from other information providers. As an FCRA-compliant consumer reporting agency, CoreLogic gathers records from businesses across the country who cater to non-traditional credit consumers. 2nd Notice: 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. This transaction is deemed to have taken place in Delaware and all regulations governing this transaction are in accordance with Delaware law If you are in need of help with credit coulnseling, please refer to the National Foundation for Credit Counseling located here