Omaha Cash

Online Application

Tel: 402-333-2630

Fax: 402-333-8978

 

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*** Attention Please ***

 

If you are using a public accessible computer

To protect your privacy, once your information has been submitted or sent to the printer

Be sure to CLOSE THE BROWSER.

 

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Social Secutiy Number:	- -
Are you, your spouse, or are you a dependent of a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard?	No Yes
Drivers License#:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
License Issue Date:
License Experation Date:

First Name:
Middle Innitial:
Last Name:
Are you atleast 18:	No Yes
Date of Birth:: Ex. (Month/Day/Year)
Phone Number:
E-Mail Address:

 

Mailing Address:
Apt #:
City:
Sate:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Do you own or rent:	Own Rent
Time there:

 

Any other outstanding checks at any other check cashing stores:	No Yes
If so, how many stores:	None 1 2 3 4 5
Name of Stores:

Employer:
Position:
Since:
Supervisor:
Business Phone #:
Pay Periods:
Net Income Per Month:
Direct Deposit:	Yes No
Ever Declared/Filed Bankruptcy:	No Yes
If so, when:
Do you plan on filling?	No Yes
If so, when:

Personal References (Not Living With You)
1. Friend/Relative        _______________________________________________  

Name:
Phone Number:
Complete Address:

 

2. Friend/Relative        _______________________________________________  

Name:
Phone Number:
Complete Address:

 

*Please Note:

WHEN THERE IS A JOINT ACCOUNT, (WIFE, HUSBAND, FRIEND, RELATIVE) THE OTHER SIGNERS ALSO MUST COMPLETE AN APPLICATION TO POST DATE A CHECK WITH US. THE PERSON WHO SIGNS THE CHECK MUST ALSO BE THE SAME PERSON SIGNING RECEIPT FOR THE CASH ADVANCE.

Right to Privacy:

You agree that Omaha Cash, Inc. may contact and share information with any agencies, relatives, or persons, including but not limited to, your place of residence and employment, your neighbors, consumer credit reporting agencies, including those in connection with the application, processing, funding, servicing, repayment and collection of your transaction with Omaha Cash, Inc. To the extend not prohibited by law, you waive any privacy claims against Omaha Cash, Inc. Your customer application and Deferred Deposit Agreement will remain the property of Omaha Cash, Inc.

Bank Information For Cash Advanced

Bank:
Bank Phone Number (w/ Area Code):
Bank Routing Number:
Bank Account Number: (Bank Routing and Account Numbers are located on the bottom of your personal check.)
Complete Address:
Phone Number:
Complete Address:

 

After being approved, the amount I am requestion for my first advance based on 1 week of net income as determined by your current pay stub is:	Sample Rate Chart
Repayment due date: 2 weeks or next pay date, whichever comes first.

 

UPON APPROVAL, I authorize Omaha Cash, Inc. to make me a payday advance (in the amount that I will be approved for, which I acknowledge may be less than the amount requested.) If I do not pick up and repay the cash advance on the agreed upon due date, my check will be deposited. I understand and agree the cash advance received is due for pick up and payment on my NEXT NEAREST PAY DATE (up to maximum of 14 days)

 

I agree/understand I will be contacted by telephone or electronic e-mail at the number or address provided on this application to confirm my conditionally approved cash advance amount. I agree to maintain an adequate balance and keep my account(s) open to allow all personal checks deposited and made payable to Omaha Cash to occur in a timely manner for the scheduled agreed upon repayment due date.

 

I further agree and confirm that by submitting completed, signed www.bigocash.com Internet Application it is a matter of convenience to me. I agree to personally visit Omaha Cash at 14626 West Center Road, Omaha, Nebraska with my completed, signed, and dated check prior to receiving cash advance.

 

If my personal check is returned for ANY reason, I agree that I will also pay a $15.00 return fee.

 

I further agree and represent by submitting an application, that I am not presently involved in, nor contemplating bankruptcy proceedings now or in the future.

I have read, understand, and agree to ALL terms, disclosures, and conditions of the Omaha Cash Internet Master Pay Day Cash Advance Application Agreement. (MUST SELECT ONE!)

I Agree I Disagree

 

TYPE YOUR NAME AS YOUR ELECTRONIC SIGNATURE

I would like to receive special offers from Omaha Cash, Inc. by email.

Once you are approved, how would you like to be contacted? Email Telephone

 

Any additional comments:

 

How did you hear about our service?	Friend Radio TV Yellow Pages Thrifty Nickle Other
If "Other" please describe:

I ACCEPT - Click Submit Application to submit your application for processing.

(Click Cancel to DELETE the information above)

 

Faxing Instructions              You need to PRINT, SIGN, and FAX to 402-333-8978 with the required verification items.           If you experience any problems in submitting this application - please call (402) 333-2630