First Name

Last Name

Select Location

Social Security Number

Re-Enter Social Security Number

Type of Loan

Drivers License/State ID Number

State of Issue

Loan Amount

Email Address

Confirm your Email Address

Home Address

Suite/Apt #

City

State

Zip Code

Date of Birth

Home Phone

Cell Phone

Monthly Mortgage/Rent

Monthly Gross Income

Employer

Job Title

Work Phone Number

Bank Name

Vehicle Information for Title Pawn

Year

Make

Model

Mileage

Military Information

Federal law provides important protections to active duty members of the Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, we require you to check one of the following statements as applicable

Warning: It is important to fill out this form accurately. Knowingly making a false statement on a credit application is a crime.

I AM NOT a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or 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 member).

I AM 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.

 I AM a dependent of a member of the Armed Forces on active duty as described above, because I am the member's spouse, the member's child under the age of eighteen years old, or I     am an individual for whom the member provided more than one-half of my financial support for 180 days immediately preceding today's date.

Terms & Conditions

By checking here you agree that we may (i) call you at any number provided on your credit application, including your cell phone,  (ii) write you, via US postal service and/or electronic mail or (iii) contact you by text message or other wireless communication method on any telephone number listed on your application, in order to inform you about special promotions, savings and services we believe may be of interest to you as well as account status information. You may be charged by your wireless provider in order to receive text messages. You may change your contact preferences by logging into My Account and selecting "Update Info" at any time or by calling us at 423-877-8880 or emailing us at support@advcheck.com.

Sign Here

Advanced Check Cash Advance does not require a credit report to approve a loan but we do use TeleTrack which is a service that provides us with your check advance history and activity.  By entering the last four digits of your social number, you consent to allow us to access TeleTrack and to the Electronic Delivery of Disclosure as detailed below.  You also acknowledge that you have read and understand the Loan Cost and Terms, and agree to our Terms and Conditions.
 

Sign Here

CONSENT TO ELECTRONIC DISCLOSURE

Prior to making a loan to you, we must provide you with certain disclosures required by law. In order for us to provide these disclosures electronically (in this Internet application), we must obtain your consent.

By consenting to the electronic delivery of disclosures, you agree that we may, but are not obligated to, provide electronically any and all communications concerning our decision on your loan application, the terms of any loan we may extend to you, and our privacy policy (the “Disclosures”). These disclosures may include, in addition to other things, Disclosures pursuant to: the Equal Credit Opportunity Act and Regulation B; the Truth in Lending Act and Regulation Z; the Gramm-Leach-Bliley Act and Regulation P; and any other applicable federal, state, or local law, or regulation. Your consent applies only to this loan application and any resulting loan and does not apply to future loan applications you may submit.

To electronically receive, view, and save the Disclosures, you must have a personal computer equipped with Netscape 4.0, Microsoft Explorer 4.0 or AOL 5.0 or later version, and either a printer, a hard drive, or other storage device. You must also have a valid email address.

Prior to submission of your application, you may withdraw your consent to electronic disclosures by exiting the application website. You will not be able to submit your loan application if you withdraw your consent to electronic disclosures by exiting the application website. You will not be able to submit your loan application if you withdraw consent. In addition, because we are required to provide you with certain disclosures prior to making a loan to you, you cannot withdraw your consent after submission of your application.

You have the option to receive any information that we have provided electronically in paper form at no cost to you. To request a paper copy of any information we have provided electronically, please contact us by calling 423-877-8880, or write to us at: Advanced Check Cash Advance – Disclosure Request, P. O. Box 9040 East Ridge. TN  37412.

You must notify us of your email address changes. To notify us of your new email address, please log on to www.advancedcheckcashadvance.com and update your email address in the “Update Info” section of the website.

Please print out a copy of this consent to Electronic Disclosure and keep it for your records.

Check Advances are limited to $300 Max.

(nnn-nn-nnnn)

(nnn-nn-nnnn)

Name

E-mail Address

Phone Number

Comments