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Secure Loan Application
You have entered a secure page. All information you enter below will be sent to us securely and confidentially.

APPROVAL IN LESS THAN 30 SECONDS!

*****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 BANK ACCOUNT
PRIOR TO LOAN PAYOFF AND BECOME DELINQUENT, YOU WILL BE REPORTED.

Your IP is 38.107.191.93 and will be used to prosecute any attempts at fraud.

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 employment number where you can be contacted.

Step 2: Complete the online application below and click the button at the bottom for fast approval.

* Subject to our minimum requirements.

Loan Amount

First Name

Last Name

Social Security# Verify SSN

Driver's License #, State

Date of Birth

- - (xxx-xx-xxxx) - -

Email Address
(Enter VALID Address! IF OUR EMAILS TO YOU ARE RETURNED, PROCESSING YOUR APPLICATION WILL BE DELAYED.)

Verify Email Address

Home Address

Home City, State

Home Zip Moved in

Do You

ago.

Home Phone

Cellular

Fax Number

(xxx-xxx-xxxx)

Optional

Source of Income

Income

Job Income Benefits Income
Self Employed

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 that 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.

Employer

Employer Address

Employer City

Employer State, Zip

Work Phone

(xxx-xxx-xxxx)
ext.

NO cellular phones will be permitted - ONLY your MAIN work number.

Supervisor's Name

Supervisor's Phone

Your Position

Hire Date

Pay Cycle

Your Hire Date WILL be verified with your employer

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.

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.

Bank Name

Routing #

Bank Account Number

Verify Bank Account Number

Direct Deposit

Opened Account

Account Type

Select 'YES' if paycheck deposited directly into account

This MUST be correct, and will be verified with your bank.

Deposits

NSF's This information will be verfied with your bank.

Approximate amount deposited in the last 30 days. NUMBERS ONLY (e.g., 1500) No commas, decimals or symbols.

Select the number of NSF's on your last bank statment.

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.

I hereby give permission for 1000-Easy-Payday-Loan.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

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 1000-Easy-Payday-Loan.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@1000-Easy-Payday-Loan.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@1000-Easy-Payday-Loan.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@1000-Easy-Payday-Loan.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.