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Secure Instant Loan Application

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*****DO NOT APPLY IF YOU HAVE FILED BANKRUPTCY WITHIN THE LAST SIX (6) MONTHS.....YOUR APPLICATION WILL IMMEDIATELY BE REJECTED. BY SIGNING BELOW YOU ARE AFFIRMING THAT YOU HAVE NOT NOR ARE YOU PLANNING TO FILE BANKRUPTCY. THIS INFORMATION WILL BE VERIFIED WITH PUBLIC COURT RECORDS!!

BEWARE: WE USE CL Verify TO PREVENT FRAUD. IF YOU CLOSE YOUR CHECKING ACCOUNT PRIOR TO LOAN PAYOFF AND BECOME DELINQUENT, YOU WILL BE REPORTED.

ATTENTION: 38.107.191.85
Your IP address has been recorded to help fight internet fraud

 
NO FAXING 30 SECOND APPROVAL!
Step 1: Meet these easy requirements. *
• You are currently employed at a full time job.
• You currently have an active checking or savings account.
• You have a working home phone and work number where you can be contacted.

Step 2: Complete Express Application below and click the 'submit' button for fast approval.

* Subject to our minimum requirements.

Loan Amount     
First Name 
Last Name
Social Security #   -   -   (xxx-xx-xxxx)
Verify SSN  -   -   (xxx-xx-xxxx)
Driver's License #  (or State ID #)    State: 
Date of Birth       
eMail 

Please enter a VALID email address. We use this address to send you important information concerning your loan. IF OUR EMAILS TO YOU ARE RETURNED, PROCESSING YOUR APPLICATION WILL BE DELAYED.

Verify eMail
Home Address 
Home City   (or State ID #)    Home State: 
Home Zip    Moved in   ago.   Do You
Home Phone   (xxx-xxx-xxxx)
Cellular  Optional  (xxx-xxx-xxxx)
Fax Number  Optional  (xxx-xxx-xxxx)
References 
Name Phone # Relation
*Please provide two references that do NOT have the same home phone number, cell phone number or work phone number as yourself. You must provide two (2) different phone numbers.
Source of Income  Job Income  Benefits Income  Self Employed 
Income 

Enter your MONTHLY GROSS INCOME (only enter numbers, no commas or decimals) THIS WILL BE VERIFIED WITH YOUR EMPLOYER.

NOTE: Your monthly gross income means if you make $700 every two weeks your MONTHLY Gross income is $1400

*Or other sources of income periodically deposited to your account. However, alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

No cellular phones will be permitted - only your MAIN work number!
Your work number WILL be verified and
YOUR EMPLOYER must be listed in the PHONE DIRECTORY.

DO NOT APPLY IF YOU ARE NOT PRESENTLY EMPLOYED BECAUSE YOU WILL BE DENIED!
Primary Work Phone (Landline)  (xxx-xxx-xxxx) ext.
Contact #  Optional - used as main contact number
Employer (do not abbreviate) 
Employer Address 
Employer City 
Employer State 
Employer Zip 
Supervisor's Name 
Their Phone #  (xxx-xxx-xxxx)
Your Position    Hire Date 
Pay Cycle 

BE ADVISED THAT YOUR LOAN WILL NOT BE APPROVED UNLESS YOU ENTER YOUR CORRECT PAYDATES. THIS MUST MATCH YOUR PAYSTUB AND WHAT YOUR EMPLOYER VERIFIES WHEN WE CALL THEM. FAILURE TO ENTER THE CORRECT PAYDATES WILL DELAY DISBURSEMENT OF YOUR FUNDS.

PLEASE SELECT YOUR NEXT THREE (3) PAYDATES IF PAID MONTHLY, OTHERWISE SELECT YOUR NEXT FOUR (4) PAYDATES.

YOUR FIRST PAYDATE SELECTED MUST BE AT LEAST SEVEN (7) DAYS FROM TODAY.

THESE PAYDATES ARE FOR VERIFICATION OF YOUR PAY CYCLE ONLY, AND DO NOT INDICATE A PAYMENT SCHEDULE OF ANY KIND.

IF YOU CHOOSE TO CONTINUALLY RENEW YOUR OUTSTANDING PRINCIPAL BALANCE, YOU WILL HAVE SIGNIFICANTLY MORE THAN JUST FOUR PAYMENTS.



  
   
 
Sample check

YOU MUST BE LISTED AS AN ACCOUNT HOLDER AND SIGNER ON THIS ACCOUNT. IN ORDER TO PREVENT FRAUD, THIS INFORMATION WILL BE VERIFIED WITH YOUR BANK.

YOU MUST HAVE BANK ACTIVITY IN YOUR CHECKING ACCOUNT THAT YOU LIST
OR YOU WILL BE DENIED
Direct Deposit  Select 'YES' if your employer deposits your paycheck directly into the bank account that you are applying with.
Account Type 

Opened Account 		  
This MUST be correct, and will be verified with your bank.
IF YOUR ACCOUNT HAS NOT BE OPENED FOR A MINIMUM OF FOUR (4) MONTHS, YOU WILL BE DENIED!
Bank Name 
Routing # 
Account # 
Verify Account #
Dollar Amount Deposited  Approximate AMOUNT deposited to the checking account you listed above in the last 30 days. NUMBERS ONLY (e.g., 1500) No commas, decimals or symbols.
  This information will be verified with your bank.
NSF's  Select the number of NSF's on your last bank statement.

I hereby give permission for National-PaydayLoan.com to verify the above information for a credit decision based on the verified information.  Please see Privacy Policy and Frequently Asked Questions.  In accordance with the "Electronic Signatures in Global and National Commerce Act," by typing my name in the signature box below I understand it is as legally valid and binding as a written signature. I also certify that the above information is true to the best of my knowledge.
Send me details on other offers. Yes No
Signature 
For Instant Approval Click Here

CONSENT FOR ELECTRONIC RECORDS.

Please read this information carefully and print a copy and/or retain this information electronically for future reference.

Introduction. You are submitting a request for a loan ("Application") from National-PaydayLoan.com ("Us"). We can only give you the benefits of our on-line service if you consent to the use or acceptance of electronic signatures and to the use or acceptance of electronic records or disclosures in this loan transaction ("Your Consent"). By completing and submitting the Application on-line, you acknowledge receipt of this document and consent to use electronic signatures and to conduct this transaction by use of electronic disclosures and contract documents ("Records").

Electronic Communications. You may request a paper copy from Us of any of the Records by writing to Us with the details of your request at: customersupport@National-PaydayLoan.com.  Your request for paper copies may be made after Your Consent and after any withdrawal of Your Consent.We will provide the paper copies to you at no charge. We shall retain the Records as required by law.

Consenting to Do Business Electronically. Before giving Your Consent, you should consider whether you have the required hardware and software capabilities described below.

Scope of Consent. Your Consent and our agreement to conduct this transaction electronically only apply to this transaction. By exercising Your Consent, We will conduct this transaction with you electronically.

Hardware and Software Requirements. To access and retain the Records electronically, you will need to use the following computer software and hardware: An IBM or MAC compatible computer with Internet access  and an Internet Browser that meets the following minimum requirements. Netscape Navigator 4.08/Netscape Communicator 4.7 or later versions or Microsoft Internet Explorer 4.01 or later versions (4.51 for Mac users). Also, the specific Internet Broswer must support at least 128 bit encryption. To read some documents, you will need a PDF file reader like Adobe Acrobat Reader.  If at any time during this transaction these requirements change in a way that creates a material risk that you may not be able to receive Records electronically, We will notify you of these changes.

Withdrawing Consent. You are free to withdraw Your Consent at any time and at no charge to you. If you do withdraw Your Consent prior to receiving the loan, this will prevent you from obtaining a loan with Us over the Internet. If at any time you wish to withdraw Your Consent, you can send us your request by email to: customersupport@National-PaydayLoan.com. If you decide to withdraw Your Consent, the legal effectiveness, validity and/or enforceability of prior electronic Records will not be affected.

Change to Your Contact Information. You should keep us informed of any change in your electronic address or mailing address. You may contact Us by e-mail at customersupport@National-PaydayLoan.com regarding any such changes.

YOUR ABILITY TO ACCESS RECORDS. BY TYPING IN YOUR NAME ABOVE, YOU ACKNOWLEDGE THAT YOU CAN ACCESS THE RECORDS IN THE DESIGNATED FORMATS DESCRIBED ABOVE.

CONSENT.   YOU ACKNOWLEDGE THAT YOU HAVE READ THE INFORMATION ABOUT ELECTRONIC SIGNATURES AND DOING BUSINESS ELECTRONICALLY IN THIS CONSENT FOR ELECTRONIC RECORDS. YOU CONSENT TO USING ELECTRONIC SIGNATURES, HAVING ALL RECORDS PROVIDED OR MADE AVAILABLE TO YOU IN ELECTRONIC FORM AND TO DOING BUSINESS WITH US ELECTRONICALLY. YOU ACKNOWLEDGE THAT YOU MAY REQUEST A PAPER COPY OF THE RECORDS, WHICH WE WILL PROVIDE TO YOU AT NO CHARGE. YOU HAVE AGREED TO RECEIVE THE LOAN PROCEEDS ELECTRONICALLY AND TO REPAY THE LOAN ELECTRONICALLY.

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Copyright 1992, National-PaydayLoan.com All Rights Reserved.

This service does not constitute an offer or solicitation for short-term loans in all states. This service may or may not be available in your particular state. The states this site services may change from time to time without notice. Borrower is responsible for complying with any local statutory obligations that may exist in their state or area with respect to any transactions with National-PaydayLoan.com.

Loans are NOT available to residents of WV, KS, CO, GA, MA, OK, MT, CA, NC, AR, OR and ID.