A1A FastCash Agreement

The below agreement must be signed and returned to us as part of your application. Please print out and sign the below agreement and fax to us at 1 (866) 434-FAST (3278) along with:

- Most Recent Bank Statement
- Most Recent Pay Stub
- Copy of Your Driver's License
- Copy of a Voided Personal Check
- Printed Copy of this Agreement Signed and Dated

(* Please use photo-quality mode, if your fax offers this option*)

The purpose of this Agreement is to insure that you are informed of all the terms, conditions and policies of A1A FastCash. This should remove all “The Fine Print” and hopefully make you, our valued customers, more comfortable in all your dealings with A1A FastCash.

Please visit http://www.a1afastcash.com/eng/app/agreement.asp for the complete agreement and definitions.

AGREEMENT AND AUTHORIZATION FORM

1.) I acknowledge that I have read, understand, and agree to all the conditions, terms, and disclosures of the A1A FastCash agreement.

2.) I acknowledge that I have provided my banking information, including routing and account number for A1A FastCash to use for debit/credit transactions.

3.) Once approved, I give A1A FastCash authorization to deposit a cash advance into my account. This amount will be my “Amount Financed”.

4.) I understand that the “Amount Financed” may be less than the amount I requested.

5.) I authorize and approve A1A FastCash to withdraw the “Amount Financed” plus the “Finance Charge” on my “Payment Date” as determined by the application. And that that date should be my next payday.

6.) I confirm and promise that I am not currently in bankruptcy proceedings nor am I planning on filing bankruptcy in the future.

7.) I understand that if I chose to pay for an extension on my loan, that paying the “Extension Fee” in no way decreases my “Payoff Balance”, and that if I wish to decrease my “Payoff Balance” I must pay an additional amount above and beyond my “Extension Fee”.

8.) I understand that all transactions will be deemed to have taken place in the State of Delaware regardless of where I viewed, submitted or accepted this application and agreement.

9.) I understand and agree that this agreement and authorization are binding and valid for now and as requested in the future and will remain in effect.

SIGNATURE ________________________________

PRINT NAME ________________________________

SS#_______________________________ DATE_______________