Dells Fast Cash Advance Application

Fast Cash, LLC
d.b.a. Dells Fast Cash

Please complete all sections of this application. We cannot process incomplete forms.

  • Client Information

  • Employment Information

  • Banking Information

  • Landlord Information

  • Co-Applicant Information

  • Personal References:

    Please list the name, address, phone number and relationship information for references
  • Other Cash Advance Information

  • Arbitration

  • Arbitration is a means for legal matters between parties to be resolved by a neutral arbitrator rather than a Court. Fast Cash, LLC has a policy of arbitrating all claims, demands and disputes which cannot be resolved in a small claims tribunal, including the scope and validity of this arbitration provision and any right you may have to participate in an alleged class action (hereinafter "dispute(s)"). All customer agreements contain another arbitration provision that supersedes this arbitration provision and governs the resolution of disputes. However, if you do not enter into a customer agreement with us, then this arbitration provision governs the resolution of disputes. You agree that YOU ARE WAIVING YOUR RIGHT TO HAVE A TRIAL BY JURY to resolve disputes against us, our agents and/or owners. The Federal Arbitration Act governs this arbitration provision. If either party has a dispute, they must notify the other in writing of the dispute. You have the right to select any of the following arbitration organizations, which will govern the arbitration under its consumer rules; American Arbitration Association (1-800-778-7879) http://www.adr.org, J.A.M.S./Endispute (1-800-626-5267) http://www.jamsadr.com, or National Arbitration Forum (1-800-474-2371) http://www.arbforum.com, and we will advance all of the expenses associated with the arbitration, including the filing, administrative, hearing and arbitrator's fees. You will be responsible for your attorney's fees, if any. Any appeal of a judgment from a small claims tribunal shall be resolved by binding arbitration. The arbitrator shall not conduct class arbitration. The arbitration hearing will be conducted in the county in which this Application is signed.
  • Other Important Information:

  • (Please read this information before signing the application)

    Please Read Before Signing: I certify that the information supplied by me is true and correct and that the information concerning my income, obligation and employment is correct. I further certify and acknowledge that I have the ability to repay the loan. I authorize verification of the truthfulness of all information continued herein, including contact with any person or firm listed above, and I fully release all parties from any damage that may result. Any false statement made by me shall be sufficient basis for rejection. I have read and understood the above statements. I acknowledge that this application and any supporting documents provided with it is the property of Fast Cash, LLC. Alimony, maintenance payments, or child support need only be provided if those amounts are to be used to determine eligibility.  Wisconsin Married Residents: The loan being applied for, if granted will be incurred in the interest of my marriage or family. I understand Fast Cash, LLC may be required by law to give notice of this credit transaction to my spouse. (see the next 2 questions)

    NOTICE TO MARRIED WISCONSIN APPLICANTS: No provision of a marital property agreement, a unilateral statement under s. 766.59 or a court decree under s. 766.70 adversely affects the interest of the creditor unless the creditor prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.

  • Marketing Information (Optional)

  • STATEMENT OF MILITARY STATUS

    In compliance with Section 670 of John Warner National Defense Authorization Act for Fiscal Year 2007, effective October 1, 2007,
  • By signing below, I hereby authorize the lender to use the information contained in my loan application to verify my military status now and at any time any portion of an amount financed remains owed should I qualify for a loan.

    * The John Warner National Defense Authorization Act defines a "covered member" as a member of the armed forces who is (a) on active duty under a call or order that does not specify a period of 30 days or less; or (b) on active Guard and Reserve duty.

    ** "Dependent" is defined as "the member's child" or "an individual for whom the member provided more than one-half of the individual's support for 180 days immediately preceding the date of this application."

  • This field is for validation purposes and should be left unchanged.

This Statement must be completed by each applicant.