Cash Advance Application - Direct Cash Advances

Name*

First Last

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Date of Birth*

Untitled*

Yes, I give Advance America permission to send me account maintenance and marketing text messages to this mobile phone number and to call me at this number using an automatic dialing system. I understand that any messages sent may be read by anyone with access to my mobile device. I am confirming that the mobile number provided belongs to me. I understand that my mobile phone number provider may charge fees for text messages that are sent, and I agree that you have no liability for the cost of any text messages. I understand that I can choose to stop receiving marketing text messages by replying "STOP" to any marketing text message that I receive or by calling 1-844-333-5493. To stop all text messages, I may reply "STOP ALL." I may also withdraw my authorization to be contacted by an automatic dialing system by calling 1-844-333-5493.

Social Security Number*

Applying does not impact your FICO credit score.

Your social security number is needed to verify your identity and is required to complete the application process.

Confirm SNN*

Choose a Loan*

Pay Day Loan ($100 - $500)

Installment Loan ($2,000 - $3,000)

Loan Amount*

Tell Us About Your Income

Main source of Income*

Income from alimony, child support, or separate maintenance payments do not have to be included.

Employer Name*

Work Number*

Paycheck Before Taxes*

This is your Gross Pay, or your total earnings before taxes and deductions are taken out. This includes overtime and holiday pay. Please round up to the nearest whole dollar.

Paycheck After Taxes*

This is your Net Pay, or your total earnings after taxes and deductions are taken out. This includes overtime and holiday pay. Please round up to the nearest whole dollar.

Are you paid by Direct Deposit?*

Yes

No

How often are you paid?*

When is your pay date?*

Where Do You Want Your Money Deposited?

Where can I find my routing & checking account information?

Here are some ways these can be found.

Check your banking online account or mobile app
Contact your bank’s customer service
Paper bank statement
On your paper checks

Routing/ABA Number*

Bank Name*

Checking Account Number*

Please review the following disclosures.*

I agree to the Electronic Communications Consent Policy and have been provided with the Privacy Policy .

The information I have provided is true and correct and I understand that Advance America will access a third party credit bureau and/or identity verification service to approve my loan.

Signature*