If Submitting Application by Fax: 1. Complete the form below. 2. Print off your completed application. 3. Fax your completed application to us at 416-636-2549. OUR APPROVAL CENTER WILL CONTACT YOU WITHIN 1 TO 24 HOURS IF APPLYING BY FAX. PERSONAL INFORMATION   FIRST NAME: INITIAL: LAST NAME:   SIN: HOME ADDRESS: APT #/UNIT#:   CITY: PROVINCE: POSTAL CODE: COUNTRY:    PHONE NUMBER: CELLULAR: OTHER:   FAX NUMBER: EMAIL ADDRESS:   LIST ONE REFERENCE:   COMPLETE NAME: PHONE NUMBER: RELATIONSHIP:   MAY WE CONTACT YOU AT HOME? YES NO EMPLOYMENT & INCOME INFORMATION   WORK PHONE: TAKE HOME PAY PER PAY-CHEQUE: $  CAN YOU RECEIVE CALLS AT WORK? YES NO   WHAT IS YOUR POSITION? HOW LONG HAVE YOU BEEN WITH THIS COMPANY? Yrs      Mths    EMPLOYER NAME: ADDRESS: UNIT #:   CITY*: PROVINCE: POSTAL CODE: COUNTRY:  BANKING INFORMATION   DO YOU HAVE A VALID CHECKING ACCOUNT? YES NO BANK NAME: BRANCH #:   ACCOUNT #: MAJOR INTERSECTION:   HAVE YOU HAD ANY RETURNED ITEMS WITHIN THE LAST 45 DAYS? YES NO DO YOU MAKE REGULAR DEPOSITS AND WITHDRAWLS ON THIS ACCOUNT? YES NO QUESTIONS & ANSWERS   HOW DID YOU HERE ABOUT OUR SERVICE?   WE OFFER LOANS UP TO $1000.00 UNTIL YOUR NEXT PAY DAY.   HOW MUCH ARE YOU LOOKING TO BORROW? $  WHEN IS YOUR NEXT PAY DAY? Sunday Monday Tuesday Wednesday Thursday Friday Saturday   January February March April May June July August September October November December   12345678910111213141516171819202122232425262728293031   2003200420052006200720082009   ARE YOU PAID: Weekly Bi-Weekly Twice a month Monthly IS YOUR PAY DIRECTLY DEPOSITED? YES NO ARE YOU SELF EMPLOYED? YES NO   DO YOU WORK ON CONTRACT OR COMMISSION? YES NO HAVE YOU EVER DECLARED BANKRUPTCY? YES NO   DO YOU HAVE ANY GARNISHMENTS OR ARE YOU PRESENTLY INVOLVED IN ANY TYPE OF LAW SUIT? YES NO   PLEASE READ: I CERTIFY THAT ALL QUESTIONS HAVE BEEN ANSWERD TRUTHFULLY AND ACCURATELY. ALL INFORMATION PROVIDED BY ME IS PRIVATE AND CONFIDENTIAL. I GIVE THE PROCESSING CENTER OF THE COMPANY FULL AND COMPLETE AUTHORIZATION TO REVIEW THIS APPLICATION FOR THE PURPOSE OF GRANTING ME A SHORT TERM LOAN. THE COMPANY MAY CONTACT MY BANK AND EMPLOYER FOR A REFERENCE. IF I AM APPROVED I RESERVE THE RIGHT TO DECLINE ANY OFFER PRESENTED TO ME BY THE COMPANY.   Signature (if faxing application): Printed Name (if faxing application): Dated:   OFFICE USE APPROVED:           DECLINED: E.V. DATE       P. V        C.C. YES . NO        D.T.