Advance Amount Requested:
(CLICK HERE to see our complete Fee Schedule).
Advance due/Deposit date: (must not exceed 14 days or date can't fall on a holiday, or weekend).
Your Name:
Social Security Number:
(ex: 111223333)
(please enter with no dashes or spaces)
Driver License Number
DL Expiration date:
Home Phone:
(ex. 909-555-1212)
(include area code and ph. number, use dashes)
Work Phone:
Extension:
Fax Number:
(not required)
Your E-mail Address:
Your Address: (No P.O. Boxes)
City:
State:
Zip Code
(include +4 if possible)
Have you ever filed for bankruptcy?
Are you bankrupt now?
What is your current living situation?
Do you currently have a payday advance elsewhere?
My Employment Information:
Employer's Name:
(Name of the company you work at)
Job Title:
Name of Supervisor:
How long at present job?
Average monthly salary?:
How often are you paid?:
What day of the week do you receive your paycheck?:
Direct Deposit Status:
Personal Reference #1: (not living with you)
Reference Name:
Reference Phone:
Address:
City, State, Zip:
Personal Reference #2: (not living with you)
Reference Name:
Reference Phone:
Address:
City, State, Zip:
My Bank Information:
Bank Name:
Account Open Since:
Mother's Maiden Name:
Please enter all of the numbers which appear on the bottom of your check:
(see example below)
All of these numbers from your check must be entered. Please immediately VOID OUT the check you were using to enter this information.
What is your next check number in your checkbook?
Please check if you agree & authorize the statement below.
Customer Authorization:
I have read and agree to the terms of the agreement. Said agreement authorizes Faas Enterprises to deposit the amount requested into my checking account. Further, the agreement will authorize Faas Enterprises to debit my repayment via ACH or Demand Draft. Please type in your name below to indicate that you understand and agree to all the terms and conditions stated
Type your full legal name below
Today's Date
You will receive phone notification regarding your application within(30) minutes. What Phone Number can you be reached at during the next 30 minutes?
EXT.
If there is a better call back time, please enter it here.
How did you hear about us?
BEFORE YOU SUBMIT, PLEASE PRINT THIS FORM FOR YOUR RECORDS.
Please click Submit ONCE. It may take a few seconds for your request to be processed.
AFTER SUBMITTING PLEASE FAX THE REQUIRED PAPERWORK.
