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Customer Service
1 ▪ 800 ▪ 471 ▪ 3172

Loan Application


Customer Information* Required Fields
* First Name:
* Last Name:
* Email Address:

The first character must be an alpha character. The username must be at least four characters long. The domain name must be in the format of @XXXX.XXX and the address cannot contain special characters (#$%^&*<>).

* Date Of Birth:
* Address:
 
* City:
* Country:
* State
* Zip Code
How long at this address? Yrs. Mos.
* Home Phone:
Example: xxx-xxx-xxxx
Fax Number:
* SSN#:  -  -
* ID Country
* ID State
* ID Type
* ID Number
How did you hear about us?
* Loan Amount:
* Are you or your spouse an active military member?:
 
* Can you be claimed as a dependent by an active military member?: 
 

Employer Information
* Income Type:
* Job Title:
* Work Phone:  X
Example: xxx-xxx-xxxx
Alternate Work Phone:  X
* Employer Name:
* Address:
 
* City:
* Country
* State
* Zip Code

Payroll Information
* Type of employment:
* Have you recently filed or are you planning to file for bankruptcy?
* How do you receive your paycheck?
* Paycheck Amount*: $ .00

or other sources of income periodically deposited to your account. However, 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.

* How often do you receive a paycheck?

* How are you paid when
Pay Date falls on a
non-business day*

*Non-business days include Holidays, Weekends or any other Non-Banking Day.

* Last Pay Date
* Requested Due Date

"IMPORTANT! In order to process your application, you MUST enter a due date that is a minimum of 15 days from today's date, a maximum of 30 days from today, and is a valid business day. A valid business day includes any weekday that is not a federal holiday."

Next 2 Pay Dates:
  
These MUST be accurate to calculate your loan.

Bank Information
Picture of align check
* Bank Name:
* Account Type:
Bank Country:
* ABA Number:
* Acct. Number:

Reference Information
Please supply 2 contacts, one must be a relative NOT living with you.
We WILL NOT CONTACT any of your personal contacts to qualify your loan.
Personal Contact #1
* First Name:
* Last Name:
* Phone Number:
Example: xxx-xxx-xxxx
* Relationship:
Personal Contact #2
* First Name:
* Last Name:
* Phone Number:
Example: xxx-xxx-xxxx
* Relationship:

Terms and Conditions
By checking the "I Agree" buttons below you are stating that you agree to the following terms and conditions.
* Auto Dialer/Wireless Device Consent
I Agree
 
* Consent to Electronic Communications
I Agree
 
* Teletrack Consent
I Agree
 
X

Auto Dialer/Wireless Device Consent

You agree that we may contact you about your account using any contact information you provide including but not limited to home, work, cell phone, or wireless device numbers (either now or in the future). You expressly agree to the use of any automatic telephone dialing system and/or automated or prerecorded voice when contacting you and acknowledge that you may incur charges under your phone plan as a result. By electronically signing this consent by checking the “I AGREE” box below, you are confirming that you have agreed to the terms and conditions of this Consent to being contacted using any of the methods previous mentioned. You can withdraw your consent given herein by calling us at 1-800-471-3172.

X

Consent to Electronic Communications

Please read this information carefully. Print and retain this information electronically for future reference.

  • Conducting Business on the Internet. We are an internet based business. In order to conduct business with you over the internet, we must obtain your consent to allow us to communicate with you electronically. This communication informs you of your rights when receiving electronic communications from us.
  • Consent to Conduct Business Electronically. By granting your consent to us, you agree that any and all, present and future, communications from us relating to your use of our web site, (unless withdrawn), may be provided to you or made available electronically, either by e-mail or at our website. Should you consent, you are still entitled to receive a free paper copy of any communication from us by contacting us in the manner described below.
  • Scope of Consent. Your consent to do business and receive communications electronically, along with our agreement to do so, shall apply to all of your transactions with us.
  • Hardware/Software Requirements. In order to gain access and store the communications electronically, you will need access to a computer with Internet Explorer 4.0 or above, Netscape Navigator 4.0 or above, or similar software, an email address, ability to check email, and hardware capable of running this software.
  • Withdrawal of Consent. Your consent to receive communications electronically may be withdrawn by contacting us in the manner described below. Should your consent be withdrawn, from that time forward, you will not be able to apply for new services or loans. The withdrawal of your consent will not affect the legal validity and enforceability of any pending loans obtained through our web site, any electronic communications provided, or business transacted between us prior to the time your consent is withdrawn. Subsequent to the withdrawal of your electronic consent, it will be necessary for us to contact you by mail or other non-electronic means.
  • Paper Copies of Communications. When we receive your written mail-in request to the address below, our support center will provide you with requested electronic communications at no additional charge.

DFM Group, LLC
P.O. Box 80337
Chattanooga, TN 37414

• Keeping Your Contact Information Updated. Please keep us informed of any changes to your email or physical mailing address so that you may continue to receive all communications without unnecessary interruption.

•Contacting Us. You can withdraw your consent to electronic communications with us be calling our support center staff toll free at 1-800-471-3172.

By clicking on the "I Agree" button below, you are acknowledging that you are able to access the electronic communications in the designated formats described above, and you consent to having all communications provided or made available to you in electronic form and to conducting business with us electronically.

X

Teletrack Consent

We will be performing a search of the Teletrack database system. If you agree to allow us to perform a search of the Teletrack database system, please click "I AGREE" below.



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