Apply for your PayDay Loan

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Note: The information entered and submitted by you will be transmitted over a secure network to insure the privacy of your personal information.

* Denotes required Field

Tell Us About Yourself
*Email:
*First Name:
*Last Name:
Home Address:
*City:
*State:	Zip:
Length at Address:	&	(Calendar)
Area Codes & Phone Numbers
*Home Phone:	-
Cell Phone:	-
Home Fax:	-
Work Fax:	-
*How much are you applying for:
Personal Information For Account Security

*Social Security Number
*Date of Birth (DD-MM-YYYY):
*Drivers License or State ID:
*Issuing State:
Previously Uses Payday Loan Service:
Have any Outstanding Payday Loans
Bounced Checks-Last 30 days:

PLEASE BE TRUTHFUL ABOUT THE NUMBER OF PAYDAY LOANS OUTSTANDING AND ANY BOUNCED CHECKS WITHIN 30 DAYS. WE VERIFY THE INFORMATION WITH A NATIONAL DATABASE
Tell Us About Your Job

*Employer:
*Employer Address:
*City:
*State:	*Zip:
*Immediate Supervisor:
*Direct Work Phone Number:	-
*Number to Verify Employment:	-
*Length of Employment:	& ( Calendar)
*Hourly Rate:
*Wage Assignments / Garnishments:	(If none enter none)
If Yes, From Whom:
*Monthly Net Income: ( Take home pay after taxes. )
When Do You Get Paid?

*Pay Period:	*Please Enter Your Next 2 Paydays:
	/ /
	/ / (Calendar)
*Day You Get Paid:
*Direct Deposit:
Do you have any other income that you would like us to consider for the Application. If yes, please explain below
Add Information here.
Tell Us About Your Bank
*Bank Name:
*Bank Address:
*Bank City:
*Bank State:	Zip:
*Account Number:
*Routing Number:	(Check Example)
*Type of Account:
*Bank Phone:	-
How Long Have You Had Account::	&
Provide References: Two (2) references not living with you.

	*Name:	*Relationship:	*Home Phone
1.			-
2.			-

By typing my name below I understand that I am applying for a loan account with Cash Now Arizona and I certify that this information is true and correct. I authorize Cash Now Arizona to check any information submitted on this application.
*To sign, enter your name here:

Note: For an expedited approval, please fax your two most recent pay stubs, bank statements and a picture I.D. to one of the following numbers:

Telephone:( 520 ) 885-0817
Fax:( 520 ) 885-0819