Você está na página 1de 4

*

CUSTOMER DISCLOSURES

Our credit serv ices are intended to assist you in ev aluating, arranging, processing, and serv icing a loan from a third
party lender. Our credit serv ices help you get the cash you need to meet your immediate financial needs. This
application w ill be used by us for underw riting our credit serv ices as w ell as by a third party lender. Our credit
serv ices and any third party loan made pursuant to this Application may not be at the low est rate or best terms
av ailable. You may shop for credit serv ices and loans from other prov iders and lenders w ithout any obligation to us.
We encourage you to discuss your financial situation w ith a non-profit credit counseling serv ice that may be
av ailable to consumers in your community if you feel the need.
As part of our credit serv ices to you, w e may assist you in obtaining loans that meet your short term or longer term
needs, repaid in one or more payments. The loan product(s) for w hich you are eligible and the fee associated w ith
such product and our serv ices may v ary according to underw riting for our credit serv ices and that of the third party
lender. You should consider your financial needs in determining the loan product that best serv es you. You w ill be
charged additional fees if you renew a loan. Moreov er, if there w ere insufficient funds in your bank account on the
date w e attempted to affect an ACH debit entry to pay all of part of w hat you ow e, you w ould incur a Return Item Fee of
$30.00. Your bank may also impose fees for returning ACH debit entries unpaid and, if this practice persists, may
ev en close your deposit account. We encourage you to ask questions w ith regard to the cost of credit.

PRIVACY POLICY. Protecting your privacy is important to EZMONEY Loan Services, our employees, and the third party lender,
who may make a loan to you. We, collectively EZMONEY Loan Services, and the third party lender when used in this Privacy
Policy, want you to understand what information we collect and how we use and share the information, whether you’re a current or
former customer.

WHAT INFORMATION WE COLLECT. We may collect “non-public personal information” about you when you visit us in person,
over the phone, through the mail, or through our website from the following sources:
 From you on applications, other sources or forms;
 From your transactions with us, our affiliates or others; and
 Information we receive from consumer reporting agencies.

INFORMATION WE SHARE. We do not disclose any personal information about you to anyone, except as permitted by law. We
are permitted by law to share the information we collect from you application and other forms, transactions, and consumer
reporting agency reports, as described above, in accordance with applicable law. We may share the information that we collect
with companies that perform marketing services on our behalf or with other financial institutions with which we have joint
marketing agreements, such as marketing firms. This enables us to better anticipate and meet your financial needs. For your
protection, we require that these companies keep all personal information secure and confidential.
SECURITY OF PRIVACY. Our Associate Ethics and Code of Conduct and Privacy Agreements with our vendors and external
suppliers require that your personal information remain confidential. We restrict access to non-public personal information about
you to our Associate and agents who need to know that information to provide products or services to you. Associates who
violate our policies and procedures regarding privacy are subject to disciplinary action. Our vendors and external suppliers are
bound to uphold our procedures regarding privacy under the terms of our legal contracts with them. Plus, we maintain physical,
electronic, and procedural safeguards that comply with federal standards to guard your personal information.

NEGATIVE INFORMATION. We may report information about your account to credit bureaus. Late payments, missed payments,
or other defaults on your account may be reflected on your credit report.

ECOA NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the
basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding
contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has
in good faith exercised any right under the Consumer Credit Protection Act. The Federal agency that administers compliance with
this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580.

CREDIT SERVICES and LOAN APPLICATION


Patriot Act Disclosure
APP_CSO_TX_ EZMONEY Loan Services_10232009 Page 1 of 3
NOTICE: WE ARE REQUIRED BY LAW TO ADOPT PROCEDURES TO REQUEST AND
RETAIN IN OUR RECORDS INFORMATION NECESSARY TO VERIFY YOUR IDENTITY.
Federal law requires us to obtain, verify, and record identity information for each person with whom we do business. As a result, we will ask for your name,
address, date of birth, and other information that will allow us to verify your identity, including asking to see your driver's license or other identifying documents.
YOU MAY BE APPROVED FOR AN ADVANCE IF YOU MEET THESE SIMPLE REQUIREMENTS
 You must have a steady income.
 You must be able to show a verifiable source of recurring income payments.
 You must have a checking account with your name printed on the checks.
 You must be able to be contacted after work.
 Minimum income requirements apply. See an associate for details.
 You must not be delinquent or have an unpaid loan with the third party lender or Letter of Credit with us.
 You must not be an active duty member of the military or a spouse or dependent of an active duty member of the military.
 You must be at least 18 years old.
COMPLETE ALL THE FOLLOWING INFORMATION
PLEASE PRINT ALL INFORMATION NEATLY AND LEGIBLY IN INK
Social Security Number: Birth Date:
Name: Home Phone: ( ) Cell Phone: ( )
What is the best number to call? What is the best time to call? : AM / PM (Circle one)

Residence Address: Mailing Address:


City: State: Zip:
E-mail address:
Can w e contact you regarding our serv ices, your account, and any extension of credit including
communications to collect a debt by e-mail: Yes No
Driv er's License State: Driv er's License Number:
Security Question Choose One to Answer
Mother’s Maiden Name: City of Birth: Street Name:
2 Personal Contacts – At Least One Must be a Relative Not Living With You!
Name Relationship Phone Number
1
2
Do you hav e a checking account? Yes No Bank Name:
Employer: Hire Date:
Address: Work Phone: ( ) Ext:

City: State: Zip:


What is your superv isor's name? Superv . Phone: ( )
What is your position? Shift/Hours:
How much is your salary each pay period? * $
What are your next tw o pay dates? Next Pay Date: Second Pay Date:
Is your paycheck deposited directly into your checking account? Yes No
Hav e you recently filed or are you planning to file for bankruptcy? Yes No
Are you an activ e duty member of the military or a spouse or dependent of an activ e duty member of the
military? Yes No
*Or other source of income received periodically. Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it
considered as a source of repaying this obligation.
How long hav e you liv ed at your residence address? Year(s) Mnth(s) Rent ( ) Ow n ( ) (Check one)
Is this your first loan w ith us? Yes No If yes, how did you find out about us:
 Billboard  Community Event  Flyer/Brochure  Internet  Mail  Newspaper Ad  Passing By
 Radio  Referral  TV  Yellow Pages  Other
This Credit Services and Loan Application (“Application”) is not a promise to provide services or obtain a loan. This Application will be used by us for underwriting our credit services as
well as by the third party lender for loan underwriting. By signing below, you agree that this Application can be used and relied upon by both us and the third party lender, and treated as
a separate application by both. You acknowledge that we may accept or reject, at our sole discretion, your request for credit services, and that the third party lender may accept or reject,
at its sole discretion, your request for a loan, subject to applicable law. Until we accept your request and execute a CSO Agreement and any other documents required by the third party
lender, we shall have no obligation to provide credit services and the third party lender has no obligation to make a loan.
Assignment: You authorize us to and acknowledge that we may transfer any of our rights, titles, and interests under this Application at our discretion. You may not transfer your rights
or obligations under this Application without our prior written consent.

CSO Disclosure and Loan Terms: EZMONEY Loan Services is a registered Texas credit services organization. Our services include assisting you in the arranging, processing and
servicing of a loan from a third party lender. You acknowledge that you have been advised that our credit services and any third party loan made pursuant to this Application may not be
at the lowest rate or best terms available, and that you may shop for credit services and loans from other providers and lenders without any obligation to us. You must complete an
application at least once every six months.
See reverse side for additional Terms and Conditions

APP_CSO_TX_ EZMONEY Loan Services_06232009 Page 2 of 3


ARBITRATION AND WAIVER OF JURY TRIAL: Arbitration is a means for a neutral arbitrator to resolve legal matters between
parties, rather than a Court. You and we and/or the CSO agree to arbitrate all claims, demands, and disputes which cannot be
resolved in a small claims tribunal, including those addressing 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, including any credit services
agreement or lender loan note (“customer agreements”), contain another arbitration provision superseding this arbitration
provision and governing the resolution of disputes. If you do not enter into a customer agreement with us and/or the CSO, 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 owners and/or the CSO and its agents and owners. The
Federal Arbitration Act governs this arbitration provision. If either party has a dispute, they must notify the other in writing. You
may select among the following arbitration organizations, which will govern the arbitration under its consumer rules: the American
Arbitration Association (“AAA”) (1-800-778-7879) http://www.adr.org, J.A.M.S. (1-800-351-5264) http://www.jamsadr.com/
(“JAMS”), or National Arbitration Forum (1-800-474-2371) http://www.arb-forum.com (“NAF”). However, you and we and/or the
CSO may agree to select a local arbitrator who is an attorney, retired judge, or arbitrator registered and in good standing with an
arbitration association and arbitrate pursuant to such arbitrator's rules. If AAA, JAMS, and NAF cannot or will not serve and the
parties are unable to mutually consent to an arbitrator, then a court will select the arbitrator. We and/or the CSO will advance all
expenses associated with the arbitration, including the filing, administrative, hearing and arbitrator's fees. You will be responsible
for your attorney fees, if any. Binding arbitration will resolve any judgment appeal from a small claims tribunal. The arbitrator will
not conduct class arbitration. The arbitrator will conduct the arbitration hearing in the county in which this Customer Application
was signed, or as the arbitrator requires.

[Specimen Signature of Joseph L. Rotunda] (Borrow er's Signature to the abov e Agreements Appears Below )

President, EZMONEY Loan Serv ices


____________________________________________________________________________________
By signing this Credit Services and Loan Application you certify that all of the information provided above is true, complete and
correct and provided to us, and/or our assigns, and any third party lender to whom we submit this Application that may consider
making a loan to you for the purpose of inducing us, any assignee, and/or any lender to provide credit services and/or a loan for
which you are applying. By signing below (i) you agree to the Arbitration and Waiv er of Jury Trial abov e; (ii) you
acknow ledge receiv ing and reading the Customer Disclosures of this Application 3; (iii) you agree that, should this
Application be approv ed by us, any assignee, or any third party lender that may make a loan and you accept the credit
serv ices and the proceeds of any loan, you agree to all of the terms of the CSO Agreement and the loan documents
that w ill be prov ided to you at the time the loan proceeds are disbursed to you; and (iv ) you authorize us to contact
you at home, at w ork, or v ia your cell phone at any time up to 9:00 p.m. regarding our credit serv ices, any Letter of
Credit that w e may issue on your behalf, or any loan that you obtain.
By signing below you authorize us to share information in your Application with any assignee, servicer, lender or third parties with
regard to the credit services and the processing, funding, servicing, repayment and collection of any loan or the Letter of Credit.

This Application will be deemed incomplete and will not be processed by us unless signed by you below.

______________________________ ___________________________
Print Name of Applicant Date

______________________________
Signature

APP_CSO_TX_ EZMONEY Loan Services_10232009 Page 3 of 3