I certify that the information supplied by me is true and correct. I authorize verification of all information contained herein. I expressly authorize contact with any person or company identified to verify any of the information or to leave a message for me. I have read and understand the above statements. I acknowledge that this application and any supporting documentation provided with it is the property of Quick Cash Of Missouri. I understand that Quick Cash Of Missouri will not perform a lengthy credit check on me, but may perform a search in the Tele-Track database. I agree to and authorize such a search and credit analysis. I understand that upon approval of my application I will be required to sign a Waiver of Jury Trial and Arbitration Provision. By agreeing below, I acknowledge and agree that the Waiver of Jury Trial and Arbitration Provision will remain in effect if I cancel or terminate the transaction and will apply to any disputes I may have about this application. |
| Quick Cash of Missouri, Inc. 3799 Ridgedale Rd Ridgedale, MO 65739 Ph 417-334-9083 CONSUMER PAYDAY LOAN APPLICATION |
