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DE Licensed Lender Regulations


Online Application

For fastest service please complete, print, and fax this application with a 1)voided check, 2)last paystub and 3)most recent bank statement (must be 30 day cycle) to 877-618-2288.

Please note: For a Spanish version of this form, please click here.

A short-term advance provides the cash needed to meet an immediate short-term cash flow problem. It is not a solution for long term financial problems for which longer term financing may be more appropriate. You may want to discuss your financial situation with a credit counseling service in your community. You will be charged additional fees if you renew/extend the advance. Any borrower does have the right of recission. There will be no charge if you change your mind and return the amount borrowed on the same business day the loan was received.

Amount Requested:
Is this Fast Cash? yes no Fast Cash Fee
Name:
Address:
City:
State: Zip:
User ID:
(please create)
6-12 letters/numbers, please
Email Address:
Home Phone #: Rent or Own Home?
How long at address? years
Fax #:
Social Security #:
State ID #:
Birth Date:
Employer:
Employer Address:
Employer Phone:
How long have you worked there? Hire date:
Position:
Shift/Hours:
Supervisor's Name:
Supervisor's Phone #: Extension:
Your Gross Monthly Pay:
Your Net Pay:
ABA #:
Bank Account #:
Bank Phone#:
FAST Cash only)
Bank Wire Routing#
(
FAST Cash only)
Is your paycheck deposited directly into your checking account? Yes No
What are your two next paydates?
How often are you paid? Weekly Bi-Weekly Twice Monthly Monthly
Please supply two (2) references who do not live with you:
First Reference Name:
First Reference Phone: Relationship:
Second Reference Name:
Second Reference Phone: Relationship:
How did you find us?
Number of current payday loans with other lenders:
If so, how much is due?

NOTICE: YOU AND WE WOULD HAVE HAD A RIGHT OR OPPORTUNITY TO LITIGATE DISPUTES THROUGH A COURT AND HAVE A JUDGE AND JURY DECIDE THE DISPUTES BUT HAVE AGREED INSTEAD TO RESOLVE DISPUTES THROUGH BINDING ARBITRATION.

AGREEMENT NOT TO BRING OR PARTICIPATE IN CLASS ACTIONS: To the extent permitted by law, by signing below you agree that you will not bring, join or participate in any class action as to any claim, dispute or controversy you may have against us or our agents, servicers, directors, officers and employees. You agree to the entry of injunctive relief to stop such a lawsuit or to remove you as a participant in the suit. This agreement is not a waiver of any of your rights and remedies to pursue a claim individually and not as a class action in binding arbitration as provided above. This agreement not to bring or participate in class action suits is an independent agreement and shall survive the closing and repayment of the loan for which you are applying.

LICENSED AND BONDED WITHIN THE STATE OF DELAWARE: This service does not constitute an offer or solicitation for short term loans in all states. This service may or may not be available in your particular state. The states this site services may change from time to time without notice. All aspects and transactions on this site, will be deemed to have taken place in Delaware, regardless of where you may be viewing or accessing this site.

Borrower's Signature to the above Agreements Appears Below:

Applicant Signature:
Date Signed:

By typing your signature and date above on this Application, you certify that all of the information provided above is true, complete and correct and provided to us, DELAWARE FAST FUNDS OF WILMINGTON, DELAWARE, for the purpose of inducing us to make the loan for which you are applying. By signing above you also agree to the Agreement To Arbitrate Disputes and the Agreement Not To Bring, Join or Participate in Class Actions.   This Application will be deemed incomplete and will not be processed by us unless signed by you above.

Yes, I have read and agree to the above Licensed Lenders Agreement
No, I disagree with the above Licensed Lenders Agreement

After submitting this application, you must fax a copy of (1) your most recent paystub, (2) voided personal check, and (3) your most recent (30 day cycle) bank statement to 877-618-2288. Upon receipt of all your information, we will contact you within one business day to discuss your loan application.

Please print a copy of this application and save for your records!

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