Cash One - New Customer Application

1. What is your name?

	First Name
	Middle Name
	Last Name
	Gender	MaleFemale

2. How much would you like to borrow?

3. Your Social Insurance Number (SIN):

4. How can we contact you?

	Email	example: john@gmail.com
	Confirm Email
	Home Phone	()
	Cell Phone	()

5. Where do you live?

	Address	No P.O. boxes. If applicable, include apartment number.
	City
	Province
	Postal Code
	Move in date

6. When were you born?

7. Please provide us with a personal reference:

	First Name
	Last Name
	Relationship	example: mother, friend
	Phone	()

8. Debt management program

Have you recently filed or applied for Bankruptcy, Consumer proposal, Credit Counseling or entered into any debt management program?


		If 'Other' is selected, please provide details.

9. Upload a valid ID:

Please upload a valid ID (e.g. driver's license) for verification purposes.

A PDF file or a set of image files is accepted.

10. Where did you hear about Cash One?

1. What is your TOTAL monthly net income
(after taxes)?

2. Are you employed?

YesNo

3. Do you have any other income?

YesNo

1. Your Bank's Name:

2. Your Bank's Transit Number:

(5 digits)

3. Your Bank Account Number:

(7-18 digits)

Sample cheque:

4. When did you open this account?

If you do not remember the exact date, enter an approximate one.

5. Upload void cheque or direct deposit form:

A PDF file or a set of image files is accepted.

6. Do you have online banking?

YesNo

To speed up your application process, please provide us with your online banking details. This will enable us to determine your eligibility without the need for you to fax us anything.

If you do NOT have online banking, please fax or email us your most recent 3 months of banking statements to 1-866-552-2741 or service@cashone.ca

Upload most recent banking transactions:

For faster processing, please upload a copy of your last 30 days of banking as of TODAY'S DATE. (Please DO NOT log in through your mobile banking app.)

A PDF file or a set of image files is accepted.

1. How many payday loans do you NOW have?
2. How much would you like to borrow?	$
3. Do you want this loan to be re-occurring?
	YesNo
	Please note: When re-occurring is selected, you will pay only the fees on each payday. The fees you pay do not reduce the amount you owe. The fees simply carry the loan over to the following pay period or until such time, that you schedule a full pay out. If you wish to repay this loan on your next payday, do not select this option.
4. Loan Period
5. Credit delivery preference
	Direct deposit (EFT)e-Transfer (EMT)
	The delivery fee of Interac e-Transfer (also known as Email Money Transfer), is subject to a $5.00 charge.
6. Which income will you use to repay the loan?
7. Loan Agreement	I have read, understood, and accepted the terms and conditions of the Loan Agreement.

8. If you have any comment you would like to provide us, please do so here:

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