Rapid Cash Advance

Referral Coupon

Application For Cash Advance
For Returning Rapid Cash Online Customers

To apply for a cash advance, please fill out the form below completely.
You will be contacted by e-mail if you qualify for the cash advance,
and will be given instructions on how to complete the process.
This page uses a secure Internet connection ( SSL ) for protection of your information.

WARNING: YOUR INFORMATION MUST BE CURRENT.
If your are a returning customer, but you have changed any residence, employment, or banking information, you must notify us immediately. Either send us an e-mail, phone us, or fill out our New Customer Application. If you do not, and we discover any of the above information has changed, we reserve the right to cancel your cash advance application without warning, or to immediately withdraw your current cash advance for the amount that you have borrowed from us.

NOTE: FIELDS ARE REQUIRED.

Section 1 - Personal Information

Social Security Number:

( xxx-xx-xxxx )

E-Mail Address:

Name Prefix:

First Name:

Middle Name:

Last Name:

Date of Birth:

Driver's License or State ID Number:

State License or ID Was Issued:

What Are Your Next Two Pay Dates?:

Please note that your next pay date should be at least 7 days,
and it should not be more than 30 days away.

Advance Amount You Are Requesting:

Please note that if the Advance Amount you are requesting exceeds the advance amount you qualify for,
you will be notified and offered your maximum advance amount you did qualify for.

Section 2 - Cash Advance Agreement

I have read, understand, and agree to ALL of the disclosures, terms, and conditions listed in
the Rapid Cash Advances, Inc. Legal Agreement. ( You Must Select One )
To view the Rapid Cash Advances, Inc. Legal Agreement, Click Here.

I certify that all of the information provided herein is true and complete for the purpose of obtaining a Cash Advance. By applying for a Cash Advance from Rapid Cash Advances, Inc., I authorize the company, its representatives, agents, and assignees, to verify the information and the credit references I have provided, and to obtain any other credit information both now and in the future for any legitimate purpose associated with this application or the Cash Advance, including but not limited to reviewing, renewing, or collecting on the Cash Advance. I understand that if Rapid Cash Advances, Inc. approves this application, the terms and conditions applicable to the Cash Advance will be those set forth in the Rapid Cash Advances, Inc. Legal Agreement, which I agree to have read before submitting this application. I understand that I must update any of the above information at the request of Rapid Cash Advances, Inc. if any of the information changes during the life of the Cash Advance. And finally, I understand that Rapid Cash Advances, Inc. shall retain all of the information provided herein whether or not the application has been approved.

Truth-In-Lending Act Disclosure
As required by the Truth-In-Lending Act, all fees associated with this Agreement are required to be expressed as an Annual Percentage Rate(APR). This requirement provides uniformity among various credit sources, allowing you to compare rates and make the choice that is right for you.

The following table discloses this information as it pertains to this Agreement based on the information provided above.

Due Date	Length of Advance	Advance Amount	Finance Charge	Amount Due	Annual Percentage Rate (APR)

Electronic Signature
Please enter your Full Name and Social Security Number below as part of your Electronic Signature.
This must match the information entered above in Section 1 exactly!

In accordance with the Electronic Signatures in Global and National Commerce Act , by typing my name in the signature box below I understand that it will be considered as legally valid and binding as a written signature. It also acts to certify that the information supplied by me above is true and correct to the best of my knowledge.

Full Name:

Social Security Number:

( xxx-xx-xxxx )

Reference Number:

( For Internal Use Only )