Pre-Qualification Guidelines:   You understand that to execute this request YOU MUST HAVE A MINIMUM FICO SCORE OF 650-850 (630 will be considered if you are a registered Member) for a personal loan from $10,000 to $50,000; which will be available to you immediately when submitting your Membership and application.  If you do not have the required Membership Fee of $5,000.00; please note on your application accordingly, and we will deduct it immediately from your proceeds and/or bill you directly when you have been funded.  YOU MUST SUBMIT TWO (2)  MOST RECENT PAYSTUBS WITH THIS APPLICATION TO PROCESS YOUR REQEUST FOR FUNDING.  By submitting this application,  you confirm that your present Fico Score is a minimum of at least 650 or higher and that you have not recently submitted an application to this agency for processing within the last Thirty (30) Days.  Your signature below attests that you are the applicant making this request for funding and that you are not defrauding this agency for a means to seek an approval.  Your signature, whether faxed or electronic shall serve as an Original "Wet Signature" when returned to this agency for processing. 
 

	Primary Applicant » REQUIRED FIELDS NOTE: The system will not accept a hyphenated name.   » First Name:                                                                 * Use this side if faxing.     Middle Name:     » Last Name:     » Social Security #: - -        » Home Telephone: - -         » Total Yearly Household Income*: $ , .00              » Date of Birth: / / Choose Year 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903       Personal E-Mail Address:     » Residential Status: Select One Rent Home Own Home Live with Parents Other         » Years at Present Address: Yrs. Mo.         Wireless Phone Number: - -       P.O. Box:   Street Address:          » House #:      » Street Name:     » Apt. # / Additional Information:              » City:              » State: - Choose a 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              » Zip Code:
	EMPLOYMENT (Primary Applicant) » REQUIRED FIELDS   » Name of Present Employer:        Address:          City:            State: - Choose a 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             Zip Code:                           » Years at Employer: Yrs. Mo.           » Business Telephone: - - ext.

Nearest Relative Not Living With You » REQUIRED FIELDS   » First Name:   » Last Name:   Address:   City:        State: - Choose a 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                             Zip Code:                                          »Relative's Telephone Number: - -

Co-Applicant or Personal Guarantor » REQUIRED FIELDS NOTE: The system will not accept a hyphenated name.   » First Name:                                                                 * Use this side if faxing.     Middle Name:     » Last Name:     » Social Security #: - -        » Home Telephone: - -         » Total Yearly Household Income*: $ , .00              » Date of Birth: / / Choose Year 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903       Personal E-Mail Address:     » Residential Status: Select One Rent Home Own Home Live with Parents Other         » Years at Present Address: Yrs. Mo.         Wireless Phone Number: - -       P.O. Box:   Street Address:          » House #:      » Street Name:     » Apt. # / Additional Information:              » City:              » State: - Choose a 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              » Zip Code:

	EMPLOYMENT (Co-Signer or Persoanal Guarantor) » REQUIRED FIELDS   » Name of Present Employer:        Address:          City:            State: - Choose a 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             Zip Code:                           » Years at Employer: Yrs. Mo.           » Business Telephone: - - ext.

	Nearest Relative Not Living With You » REQUIRED FIELDS   » First Name:   » Last Name:   Address:   City:        State: - Choose a 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                             Zip Code:                                          »Relative's Telephone Number: - -

* Applicant understands that to complete the information below that he/she will be issued a PrePaid
   Mastercard that will report each month to all credit reporting agencies.  Applicant will receive new
   card within 5-7 business days at residence and must load funds to PrePaid Mastercard in order to
   use it.  A charge of $100.00 will be charged to the credit card number listed below, and applicant
   is authorizing Artistic! Capital Corporation, its agents, officer's and affiliates thereof to make this
   charge in order to process this new membership and loan request.

   X (Applicant Signature)   Date: 

Credit Card Information (Primary Applicant) » REQUIRED FIELDS   » First Name:   » Last Name:   Address:   City:        State: - Choose a 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                             Zip Code:                                          »Relative's Telephone Number: - -

* Applicant understands that to complete the information below that he/she will be issued a PrePaid
   Mastercard that will report each month to all credit reporting agencies.  Applicant will receive new
   card within 5-7 business days at residence and must load funds to PrePaid Mastercard in order to
   use it.  A charge of $100.00 will be charged to the credit card number listed below, and applicant
   is authorizing Artistic! Capital Corporation, its agents, officer's and affiliates thereof to make this
   charge in order to process this new membership and loan request.

   X (Co-Applicant Signature)   Date: 

Credit Card Information (Co-Signer or Personal Guarantor) » REQUIRED FIELDS   » First Name:   » Last Name:   Address:   City:        State: - Choose a 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                             Zip Code:                                          »Relative's Telephone Number: - -

Agency Fee Agreement:  If you do not have your annual Membership Fee, you must at least submit a minimum of $2,500.00 to process this request and the balance remaining plus your $1,000.00 placement fee will be billed and collected once your funds have been received.  You agree to pay to agency your balance of $2,500.00 plus your $1,000.00 agency placement fee once you have received your funds.  You understand that you will be Invoiced immediately in the amount of 12.5% for the total amount received by you, and the amount due at time of Invoicing will be returned to agency within Twenty-Four (24) hours from the date you received your loan proceeds, and/or not longer than Fourty-Eight (48) hours after receiving your funds from our lender.  To take advantage of this offer now and apply for membership and funding, you understand that you will be held in default if you do not make your payment as agreed, and you risk your new account being shutdown immediately.  Make your payment selections below as to how you are submitting your request to the agency for annual Membership and loan processing and return immediately.

(Primary Applicant)

(Co-Applicant/Personal Guarantor)

I accept the terms as they have been presented to me and I/We shall abide by the terms and conditions as outlined and understand that we shall be charged accordingly for all late payments, default, cancellation of account, collection fees, attorney fees, or any other charges as so determined by agency should I/We default in repaying the total amount billed when funds are received.

X Electronic Signature  (ALL CAPITAL LETTERS)  

DATE: 

X FAXED SIGNATURE (Primary Applicant)


_____________________________________________________


DATE:  _____________________________



X FAXED SIGNATURE (Co-Applicant or Personal Guarantor)


_____________________________________________________


DATE:  _____________________________


Certification:  You confirm that you have been quoted the rates required to approve, accept and to process your annual Membership and/or funding request as noted herein.  You understand that you will be charged a 12.5% analysis fee when your loan or line of credit account has been activated by the agency processing this application.  You agree to pay this amount, when Invoiced the same day your funds are received, and/or not less than and/or more than Fourty-Eight (48) hours from the date that you were advised your agency fee has been invoiced.  You understand that you will receive a personal checking account, where funds may be obtained from to make your payment to agency; as well as receive an ATM or Cash Access card for your convenience.  There is a late fee charged at $150.00 the first day your payment is due and not paid on time and a placement default fee of $1,000.00 for each and every day you have not brought your account up-to-date once Invoiced from the first day you received any funds whether by bank wire, credit card, line of credit, loan check, cashier's check, or all other bank draft payments or disbursement credits that may have been applied to your new account once activated. 

Your signature confirms that you agree to the terms and conditions and that you shall abide by them in its entirety when executing your request for funding placement with this agency.  Your faxed, emailed and/or original signature by directmail shall serve as an original and all faxed or emailed signatures shall replace any signature not received by directmail.

X Electronic Signature  (ALL CAPITAL LETTERS)  

DATE: 

X FAXED SIGNATURE (Primary Applicant)


_____________________________________________________


DATE:  _____________________________


X FAXED SIGNATURE (Co-Applicant or Personal Guarantor)


_____________________________________________________


DATE:  _____________________________

Referred By:  ________________________________________________________ (Required)
 

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©2003 Artistic! Capital Corporation; ALL RIGHTS RESERVED.