CAUTION: P.O. Box NOT allowed for Home Address

NOTICE: Your payment date will be based on the date you select for the "Next Pay Date" and your "Pay Interval". Generally this is the date funds are available in your bank after your pay date, however, you can alternately select a date of your choosing.

Checking this box confirms that (Box MUST be checked for "I Agree" button to activate):

• I am at least 18 years of age
• I am currently employed and earn more than $1,000 per month
• I have a valid bank account and debit card
• I am not in the process nor considering filing for bankruptcy

I understand that by clicking the "I Agree" button, I am providing 'written instructions' to Surepay Finance ("Surepay") under the Fair Credit Reporting Act authorizing Surepay to obtain information regarding my personal credit profile from credit reporting agencies. I authorize Surepay to obtain such information to evaluate the terms for offering credit, to confirm my identity, and to avoid fraudulent transactions in my name.

I further confirm that I have read and reviewed a copy of the company's Terms of Service Agreement and ESIGN Consent and agree to the use of electronic records and electronic signatures. I also authorize Surepay and its agents to place telemarketing calls and texts with an automatic telephone dialing system to the telephone number provided on this credit application. Additionally, I agree to share my application data with my merchant.

After clicking the "I Agree" button, you will receive an immediate credit decision. If "approved", you'll be given the option to secure your credit by paying a minimal Application Fee.