Dollar Loan Center

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Transaction Amount:
Enter the amount you wish to borrow: $ .00
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Social Security Number:
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Security Question
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Customer Information:
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How long have you have you lived at your current residence? Year(s) Month(s)
Do you own or rent your place of residence? Own Rent Other
Income Information:
Primary Source of Income:
How often do you receive a paycheck?
Weekly (Paid the same day every week)
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Monthly (Paid same day every month)
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Active bank account type?: Checking Savings
How do you receive your income?
Employment Information:
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Bank Information:
ABA or Bank routing number:
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Additional Information:

Federal law provides important protections to active duty members of the Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, we require you to select yes or no below:

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1. I am a regular or reserve member of the Army, Navy, Marine Corps, AirForce, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or dependent of a member of the Armed Forces on active duty. A dependent of a member of the Armed Forces on active duty as described above is the member's spouse, the member's child under the age of eighteen years old, or an individual for whom the member provided more than one-half of his/her financial support for 180 days immediately preceding today's date.Have look at best ppi claims for more information.

Yes No

Warning: It is important to fill out this form accurately. Knowingly making a false statement on a credit application is a crime.

2. Is the following statement true: After you obtain this loan, you will have no more than 2 payday loans outstanding with us or any other lender.

Yes No

3. Is the following statement true: After you obtain this transaction, the total amount of payday debt – exclusive of finance charges – that you will owe to us or any other lender will not exceed $1,000.

Yes Nos

4. Is the following statement true: The amount of this loan – exclusive of finance charges – does not exceed 25% of the gross monthly income that you expect during the term of the loan.

Yes Nos

Arbitration Agreement:
I have read, understand, and accept the terms of the Arbitration Agreement.
Consent to Receive Electronic Documents:
I have read and understand and accept the terms of the Consent for Electronic Records.

I would like to receive further information, offers & promotions.

I agree that may share my personal financial information with non-affiliated companies, as described in’s privacy policy. For example, if cannot provide me the loan or other financial product I have requested, then may share my information with an outside company that offers a similar product that may meet my needs.

WARNING ABOUT FRAUD AND IDENTITY THEFT: Attempting to obtain a credit transaction by providing false information, including but not limited to the use of false or altered documents and the use of another person's identity other than your own (Identity Theft), is fraudulent and, in some cases, punishable by law. reserves the right to report any and all information obtained in connection with a verified fraud attempt to local, state, or federal authorities including the Internet Crime Complaint Center, an FBI-NW3C partnership, for possible investigation and prosecution. For more information about the NW3C and the FBI, please visit

Notice of Furnishing Negative Information:
We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report.

By hitting the continue button, I agree the information supplied in the loan application is accurate and I have read and agree to the terms and conditions above.

By submitting the application, may offer you other available products or services.