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RETURNING CUSTOMER AGREEMENT FOR PREAUTHORIZED PAYMENT

1. Unless the authorization in item 3 below is properly and timely revoked, there will be a $15 fee and we will automaticaly convert your original advance into an extension request and charge an additional fee of $45 on any ACH debit entry items that are returned at time of collection. You authorize AtmAdvance Corporation to contact yu at your place of employmentor residence at any time up to 9:00 P.M. your local time, regarding your advance.

2.You represent that you have not recently filed for bankruptcy and have no present intentions of doing so.

3. You authorize us, AtmAdvance Corporation of California, or our servicer or agent,to initiate one or more ACH debit entries(for example, at our option, one debit entry may be initaited for the principle of the advance and another for the finance charge) to your Deposit Account indicated in your AtmAdvance Corporation application for the single payment that comes due with regard to the advance for which you are applying. The Depository Institution named in your application on file, called BANK, will receive and debit such entries to your Checking Account. This Authorization becomes effective at the time we make you the for which you are applying and will remain in full force and effect until we have received notice of revocation from you. It does not authorize us to make debit entries with regard to any other advance you may now or later obtain from that, or us with regard to this , may recur at substantially regular intervals. You may revoke this authorization to effect ACH debit entries to your account by giving oral or written notice of revocation to us, which, to be effective, must be received by us no later than 3 business days prior to the due date of your advance. However, if you timely revoke the authorization to effect ACH debit entries before the advance is paid in full, you authorize us to prepare and submit one of more checks drawn on your Account on or after the due date of your advance repayment term. This authorization to prepare and submit checks on your behalf may not be revoked by you until such time as the advance is paid in full.

4.You must provide us with a blank check from your checking account at the bank that is marked "VOID". You authorize us to correctany missing or erroneous information you provide in item 3 by capturing the necessary information from that check.

5. By signing below, you acknowledge reading and agreeing to the statements in item 1,2 and the authorization in item 3.

8. If this form has been telefaxed to you, you must print your name, date and sign below and telefax this form together with the signed advance, to (714) 917-2261

Three Business Day Policy: It is our policy not to reloan a returning customer until three full business days after the last advance was paid, to make sure all funds have cleared.

Terms Of Advance Requested:

Last Name First Name

Email address

Amount Of Advance Requested: $85,$170, or $255..

Payback Amount: $100, 200, or $300......................

Important: Before selecting a payback date it may be no more than 15 consecutive days from the day you receive your advance.

Select Payback Date(next payday).....   / /

Payback Method: Automatic debit to checking account on file.

Type Name Here To Accept Terms..

Select Date:   / /


PLEASE PRINT OUT COPY FOR YOUR FILES BEFORE YOU CLICK "SEND"


or

If faxed, Fill in these:

PRINT NAME___________________________

SIGNATURE (X) _________________________

DATE__________________________


ACH AUTHORIZATION FORM REV 06/12/2002


To check the status of your AtmAdvance request, enter your social security number here: