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Name *

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Last

Phone *

Email *

Email

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Social Insurance Number

Driver's License Number

Birth Date *

Employer Complete Name *

Do you currently have or owe for a payday loan with any payday loan company? *

Yes
No

Have you ever or do you intend to file for a Consumer Proposal or Bankruptcy? *

Yes
No

Address *

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Address Line 2

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I, hereby agree by pressing the ‘SUBMIT’ button below that Quik Cash may obtain a consumer or other report containing personal and credit information from a credit-re-porting agency in connection with this application and I authorize the release of such information. If this application is approved I authorize Quik Cash to obtain and disclose information on an ongoing basis from credit bureaus from information previously collected.

Loan Application

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