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CASH LOANS TEXAS

APPLICATION FOR CREDIT SERVICES

PLEASE REVIEW THE INFORMATION BELOW FOR ACCURACY:

CURRENT PERSONAL INFORMATION

Applicant's Name

First Name*

Last Name*

Address

Address Line 1*

Address Line 2

City*

State*

Zip*

Home Phone Number*

Cell Phone Number*

Email*

CURRENT INCOME INFORMATION

Employer

Address

Address Line 1*

Address Line 2

City*

State*

Zip*

Employer Phone

Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as part of your application. Listed below is the amount of most recent payment of other income periodically received by you, such as pension, severance, social security, alimony, child support that you wish to have considered:

$ Amount

TWO PERSONAL CONTACTS- At Least Two Must Be Relatives Not Living With You

Contact, relative not living with You*

Relationship*

Phone Number*

Contact, relative not living with You*

Relationship*

Phone Number*

Military Status – Applicant Statement

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 sign one of the following statements as applicable:

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

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.

I AM

I am not 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 (or a dependent of such a member).

I AM NOT

BY SIGNING BELOW, YOU ACKNOWLEDGE THAT THE INFORMATION YOU PROVIDED IS TRUE AND CORRECT.

Customer Electronic Signature*

Name*

Date*

Warning: It is important to fill out this form accurately. Because the information on this Application may be submitted to a third party lender to obtain an extension of credit, knowingly making a false statement on this application may be a crime.

APPLICATION TERMS AND CONDITIONS - READ CAREFULLY!

This Application for Credit Services (the "Application") is not a promise to provide any credit services to Applicant, nor is it a promise that Cash Loans Texas (“we,” “us,” “our” and “CSO”) can assist Applicant in obtaining an extension of credit. Applicant acknowledges that we may accept or reject, at our discretion, Applicant’s request for credit services. Until we accept Applicant’s request for credit services and we enter into a Credit Services Agreement with Applicant, we shall have no obligation to provide credit services to Applicant. Applicant understands that CSO is not required to submit Applicant’s request for an extension of credit to a third party lender unless CSO decides to enter into a Credit Services Agreement with Applicant.

CONSENT TO DISCLOSE INFORMATION TO LENDER: APPLICANT CONSENTS TO THE DISCLOSURE OF THE INFORMATION ON THIS APPLICATION TO PREMIER FINANCIAL ("LENDER") FOR ITS USE IN DETERMINING WHETHER TO PROVIDE AN EXTENSION OF CREDIT TO APPLICANT, SECURED IN PART BY CSO’S GUARANTY. ALL CREDIT DECISIONS WILL BE MADE BY LENDER. IF LENDER APPROVES APPLICANT FOR AN EXTENSION OF CREDIT, APPLICANT SHALL BE REQUIRED TO ENTER INTO A LENDER DISCLOSURE AND PROMISSORY NOTE.

REPORTING TO CREDIT BUREAUS: We may report information concerning your account or transaction(s) with us to credit bureaus. Late payments, missed payments or other defaults on your account may be reflected on your credit report.