Apply For a Loan With Cashmax

To apply for a loan, please fill out the form below. A representative from Cashmax will be in touch with you soon!

  1. First Name*
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  2. Last Name*
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  3. Social Security Number*
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  4. Birth Date
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  5. Driver's License Number*
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  6. Driver's License State*
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  7. Home Phone*
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  8. Mobile Phone*
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    *I agree that CashMax and its authorized representatives may contact me about special offers by calling or texting me at any number provided including cell phone, with an auto dialer or pre-recorded message. *Message and data rates may apply.
  10. How many years have you had this mobile number?*
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  11. Email Address*
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  12. Street Address*
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  13. City*
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  14. State*
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  15. Zip*
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  16. How long have you lived at this address*
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  17. Do you rent or own your home?
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  18. Bank Name*
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  19. Checking Account Routing Number*
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  20. Checking Account Number*
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  21. How long have you had this account?*
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  22. Net Monthly Income*
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    *Income disclosure: Any applicant is not required to disclose an additional income derived from alimony, child support, or separate maintenance if the applicant does not want the creditor to use this income to determine the applicant’s credit worthiness.
  23. Income Type*
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  24. Employer*
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  25. Employer Phone*
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  26. Supervisor's Name*
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  27. Date Of Hire*
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  28. Payroll Type*
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  29. Pay Frequency*
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  30. Next Pay Date*

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  31. How much is your monthly car payment?
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  32. How much is your monthly rent or mortgage?
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  33. How much is your monthly Cell Phone, Cable, and Utilities?
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  34. Reference 1 Name*
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  35. Reference 1 Mobile Phone*
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  36. Reference 2 Name*
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  37. Reference 2 Mobile Phone*
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  38. Reference 3 Name*
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  39. Reference 3 Mobile Phone*
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License

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