EZ Cash Cafe, home of the Deferred Deposit


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Preferred Member Application

We are pleased to offer another loan to meet your needs as long as the previous loan has been paid as agreed.

Please enter the following:

Your Name:

Your Preferred PIN:

Email Address:

Loan Amount:

Please enter the date that your Demand Draft and/or
ACH should be processed through your bank:

*Note: This date must not be more than 15 days after today's date.

Next Check Number:

Is this the same bank account
as used in your prior LOAN?

Yes No

If no, please enter the following

Bank Name:

Your Checking Account Number:

Customer Authorization:
Please check if you agree & authorize the statement below.
I, the Applicant forwarding this deferred deposit application, certify that the information contained in this application is true and correct, that I am over eighteen (18) years of age and that I have no current intention of filing a bankruptcy. I authorize Ezcashcafe, Inc. to investigate my credit and employment history. I understand this transaction will be governed by the Laws of California or Nevada, based upon my residency."I understand that upon approval I will receive a facsimile copy of the loan agreement and disclosure statement which describes the terms of the loan and authorizes ezcashcafe, Inc. to deposit the loan amount requested in my application into my account and to debit my loan repayment, which will include the amount of my loan and the loan fee, via ACH or Demand Draft. The loan procedes will be deposited into my bank account when Ezcashcafe, Inc. receives my signed loan agreement, in person or by facsimile."
Yes No

When would be the best time
to call?

What Number should we call?

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What Phone Number can you be FAXed at during the next 30 minutes?

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