Dollarwise Payday Loans

Please complete and submit the online form below. You will need to complete all sections to qualify for a loan. After you have filled out the form, click the button at the bottom of the page. Your form will be sent to the branch that you have selected for your payday loan.

If you fill out this form after 5:30 pm on a Friday your application will not be received and processed until the following Monday. Once you send your application you can expect to hear back from one of our representatives within 24 hours, and possibly sooner.

You will need to bring a blank check, pay stub, recent bank statement, and your photo ID to a customer service representative at the front counter of the loan center. Thank You.

Applicant Information

Name:
E-Mail:
Birthdate:
Social Security Number (optional):
Street Address:
City:
State:
Zip Code:
Home Phone #:
Have you ever filed for bankruptcy?
Who Pays the Phone Bill?
Which Dollarwise Loan Center
Is most convenient for you?


Employment Information
(if applicable)

Employer Name:
Position:
Work Phone:
Hire Date:
Weekly Salary:
Payday Schedule:
Next Payday:
Normal Work Schedule:
If Active Duty Military-
Name and Phone # of Commanding Officer:
Do You Receive Direct Deposit?


Bank Account Information

Bank Name:
Bank Street Address:
City:
State:
Zip Code:
Bank Phone #:
# Years Account Open:
Other Reg'd Account Holders:


Spouse Information
(if applicable)

Name:
Street Address:
City:
State:
Zip Code:
Home Phone #:
Birthdate:
Will Spouse Apply for Loans?


Reference Information

Relative's Name (Not Currently
Residing with You)
Relationship:
Phone #:

After you submit this application it will be delivered to the loan center you have selected.

Please bring a blank check, pay stub, recent bank statement, and your photo ID to the loan center. Thank you.


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