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Type of Loan Application:*
- Individual Credit
- Joint Credit
- Co-Maker
Amount Requested:*
Purpose of Loan:*
How did you hear about us?
Please Tell Us About Yourself...
Full Name (First Middle and Last):*
Other Names Used for Credit:
Home Phone:*
Cell Phone:
Email Address:*
Enter Email Confirm Email
(Please check one) I am a full-time resident of:*
- State of Oregon
- State of Washington
(You must either be a resident of Oregon or Washington to apply)
CashCo Home Branch (see Locations):*
Are you 18 years old or older?*
- Yes, I am 18 years old or older
Date of Birth (mm/dd/yyyy):*
Number of Dependents:*
Marital Status:*
- Married
- Separated
- Unmarried (single, divorced, widowed)
[Joint Application Only]
Full Name (First Middle and Last):*
Other Names Used for Credit:
Home Phone:*
Cell Phone:
Email Address:*
Enter Email Confirm Email
Are you 18 years old or older?*
- Yes, I am 18 years old or older
Date of Birth (mm/dd/yyyy):*
Number of Dependents:*
Marital Status:*
- Married
- Separated
- Unmarried (single, divorced, widowed)

Where You Live...
Home Street Address:*
Street Address Address Line 2 City State ZIP Code
Since (mm/dd/yyyy):*
Mailing Street Address (only if different):
Street Address Address Line 2 City State ZIP Code
[Joint Application Only]
Home Street Address:*
Street Address Address Line 2 City State ZIP Code
Since (mm/dd/yyyy):*
Mailing Street Address (only if different):
Street Address Address Line 2 City State ZIP Code

About Your Employment....
Employer's Name:*
Since (mm/dd/yyyy):*
Employer's Full Address:*
Street Address Address Line 2 City State ZIP Code
Employer's Phone:*
Your Occupation:*
Payday*
Previous Employer (if at present job less than 3 yrs.):
Since (mm/dd/yyyy):
Prev. Employer Address:
Street Address Address Line 2 City State ZIP Code
How Long:
[Joint Application Only]
Employer's Name:
Since (mm/dd/yyyy):
Employer's Full Address
Street Address Address Line 2 City State ZIP Code
Employer's Phone:
Your Occupation:
Payday
Previous Employer (if at present job less than 3 yrs.):
Since (mm/dd/yyyy):
Prev. Employer Address:
Street Address Address Line 2 City State ZIP Code
How Long:

About Your Income....
Monthly Salary:
Gross:*
Net (take home):*
Other Income:
Please specify:
Note: Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Gross:
Net (take home):
Total Income:
Please specify:
Gross:*
Net (take home):*
[Joint Application Only]
Monthly Salary:
Gross:
Net (take home):
Other Income:
Please specify:
Note: Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Gross:
Net (take home):
Total Income:
Please specify:
Gross:
Net (take home):

Personal References....
We NEED six personal references (close relatives or friends not living with you).
Reference #1
Full Name and Address*
Relationship*
Phone*
Reference #2
Full Name and Address*
Relationship*
Phone*
Reference #3
Full Name and Address*
Relationship*
Phone*
Reference #4
Full Name and Address*
Relationship*
Phone*
Reference #5
Full Name and Address*
Relationship*
Phone*
Reference #6
Full Name and Address*
Relationship*
Phone*

Vehicle information is not needed for loans under $2500, click next to continue!
Vehicle Information
Year
Make
Model
Miles
Color
License Plate #
State
VIN #
General Condition
Length of Ownership
Are you the owner?
- Yes
- No
Tags Expire (mm/dd/yyyy)
Insured by
Type of Coverage

Agreements
optional
- By checking this box you agree that we can send email to you about products and services we offer at the email address listed above. You may opt out of this information by following instructions on an email that we send you. You also agree that we may send text messages to the mobile phone number listed above. These messages may include information about products and services we offer, and may also include payment reminders or other messages about the status of loans you have with us. Your mobile provider’s charges for text messaging will apply.
required for all loans*
- By checking this box you agree to the following statement: I am applying for credit in my own name relying only on my income. I hereby warrant that I exclusively own and possess the above indicated vehicle and that no liens, contracts, or encumbrances whatsoever are on or against said vehicle. I will name the lender or any assignee of the contract as payee on my insurance policy. Everything I have stated in this application is correct to the best of my knowledge. I understand you will retain this application and any other credit information whether or not it is approved. You are authorized to check my credit and employment history and to answer questions about you credit experience with me. I authorize any person or consumer reporting agency to complete and furnish to you any information it may have or obtain in response to your credit inquiries. I further state that I am not contemplating bankruptcy at this time. The information in this application is true and complete, and I warrant that I have no debts or financial obligations not stated herein, and recognize that giving a false statement of financial condition hereon may be illegal and fraudulent and may be the basis for denying a discharge in bankruptcy.
required for joint applications
- By checking this box the joint applicant certifies that he/she is applying for credit jointly with the applicant, and that all statements in the paragraph directly above this are accurate and correct with respect to joint applicant.
Notes from Applicant
Additional Comments & Questions
Phone
This field is for validation purposes and should be left unchanged.

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