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Are you over 18 years old?

Yes
No

What is your income source?

Employment
Self-Employment

Have you received regular income from the above source for at last the past 3 months?

Yes
No

Have you applied for any payday loans, received payday loans or have been refused a payday loan in the past 30 days?

Yes
No

Do you have any active payday loans, or more than 2 other loans (excluding a mortage)?

Yes
No

Have you lived at current address for at least the past 3 months?

Yes No

I confirm that all information in this form is accurate and true.

l authorize Cash Bull Capital Inc. to do a background check on me if needed.

I understand that the information I entered in this form will be considered strictly confidential and private.

I understand that the loan I'll receive (if approved) will not be used on any illegal activities.

I agree to indemnify Cash Bull Capital Inc. and all of its employees for any liabilities or harm.

Yes No