Loan application form.

Application

YOUR INFORMATION

INCOME INFORMATION

FINANCIAL INFORMATION

BANKING INFORMATION

TERMS AND CONDITIONS

Credit Check: We will perform a credit check. The information you have provided in and with this Credit Application will be sent to one or more credit agencies for a search of their databases and for a determination as to whether or not you satisfy our credit criteria. The databases used by such credit agencies are national databases of consumers who have a record of transactions with certain lending institutions. You agree to and authorize such searches and credit analysis.

Credit Reporting:We may report information about your account to credit bureaus. Late Payments, Missed payments or Other defaults on your account may be reflected in your credit report.

Release of Information: You authorize complete verification of all information that you have provided and acknowledge that this information may be used to verify certain past and/or current credit or payment history information from third party source(s). We may contact any person or company listed above. Your application may be rejected if any information provided is found to be false or inaccurate. I understand that America's Financial Choice, Inc. will retain the information submitted in this application whether or not I am approved for a loan.

By checking the box below, I AGREE to the terms and conditions as they are detailed above. By checking the box above, I certify that everything I have stated in this Application is correct to the best of my knowledge. I also understand and consent that the information submitted in this application will be forwarded to America's Financial Choice, Inc., and that they may contact me to obtain further information.