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I
authorize and request AmeriCash Advance LLC to debit the (extension of
payment fee portion) by ACH/EFT and/or bank draft from my account on the
original scheduled repayment date for my current and existing $500 cash
advance.
I agree, that if I have not requested an additional amount to be applied
to current balance on this form, I confirm and authorize that I still
owe the original $500 advance amount plus fee (for a total amount of
$625), to be debited in full from my account on the extended date shown
above. I acknowledge and agree this extension of payment fee is $125.
*I
agree that if this is my 5th or more extension of payment request of my
original advance, AmeriCash Advance is authorized by me to automatically
debit an additional amount equal to the extension fee to be applied
towards my balance with each extension of payment request until the
balance is paid in full.
I
agree to maintain an adequate balance and keep my account(s) open to allow
all ACH/EFT and/or bank drafts to AmeriCash Advance to occur in a timely
manner for the scheduled due date. I
further
agree and confirm that by submitting completed/ signed
americashadvance.com internet request forms as a matter of convenience,
hereby constitutes the same legal and binding document as providing
AmeriCash Advance LLC with my personal post dated check, in the amount of
the cash advance plus associated fees. If
the payment is returned for ANY reason, I agree that I will also pay a
$25.00 return fee.
I
agree that upon submission of my electronic signature, I am not presently
involved in, nor contemplating bankruptcy proceedings now or in the
future.
I
understand, acknowledge, and fully agree this
transaction is made pursuant to my current outstanding promissory note/
loan document and is NOT an installment
loan that I can make payments on, but is due in full on the extended due
date above. Furthermore, it is pursuant to the Master Cash Advance
Agreement, which has been previously executed and is on file with
AmeriCash Advance.
I
understand and agree. (Please
type your signature)
�
(submit my information for processing)
�
(this will delete information given)
If
you do not receive an e-mail of confirmation that your extension of
payment request was received and processed, this will mean it was not
received by us and your account is still scheduled to debit for the full
balance due. |
