abcashnow.com Open in urlscan Pro
107.180.48.193 Public Scan

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Submitted URL:
https://eeltracklp.leadspediatrack.com/?c=44&lp=28&s1=1539-24131-&s2=1029173fbba8805a89a38d6e2c8dc7
Effective URL:
https://abcashnow.com/apply.html?affid=1539-24131-&tid=1029173fbba8805a89a38d6e2c8dc7&rid=658860003d0d1
Submission: On December 24 via manual (December 24th 2023, 4:44:54 pm UTC) from IN — Scanned from DE

Form analysis
1 forms found in the DOM

https://eeltracklp.leadspediatrack.com/post.do

<form id="pdlform" action="https://eeltracklp.leadspediatrack.com/post.do">
  <input id="lp_campaign_id" name="lp_campaign_id" type="hidden" value="61b8fa282fb27">
  <input type="hidden" id="landing_page" name="landing_page" value="abcashnow.com/apply.html">
  <input type="hidden" name="lp_redirect_fail_url" value="http://abcashnow.com/thankyou.html">
  <!-- <input type="hidden" id="date" name="dob" value=""/> -->
  <input id="lp_offer_id" name="lp_offer_id" type="hidden" value="20">
  <input id="leadid_token" name="jornaya_lead_id" type="hidden" value="64FA6B59-F487-C3ED-1157-CE3DC37FB258">
  <input type="hidden" id="user_agent" name="user_agent" value="Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/120.0.6099.109 Safari/537.36">
  <input type="hidden" id="lp_s1" name="lp_s1" value="1539-24131-">
  <input type="hidden" id="lp_s2" name="lp_s2" value="1029173fbba8805a89a38d6e2c8dc7">
  <input type="hidden" id="ip_address" name="ip_address" value="185.213.155.137">
  <input type="hidden" id="tcpa_text" name="tcpa_text"
    value="
                      I certify I am a US Resident, Age 18+. I have read &amp; agree to the Disclaimer, Privacy Policy, Terms &amp; Terms of Use, and E-consent. I authorize ABCashNow.com to share my information with lenders, lending partners, and marketing partners and for these parties to use my information to obtain consumer report information on my credit profile. I also give express written consent to receive recurring communications from them and ABCashNow.com, including live, autodialed and prerecorded text messages (SMS), emails, and calls regarding my request and related services at the number provided even if my number is on the state/federal Do-Not-Call list. I understand that my consent to receive communications is not required to use this Site’s services and partners of ABCashNow.com, I understand that providing consent to be contacted is not a condition to purchase any good or service.">
  <center>
    <h1>Basic Details</h1>
  </center>
  <div class="row contact-form-wrap justify-content-center">
    <div class="col-md-6 contact-name form-col">
      <select name="loan_amount" id="loan_amount" class="form-control" required="">
        <option value="">Loan Amount:</option>
        <option value="100">$100</option>
        <option value="200">$200</option>
        <option value="300">$300</option>
        <option value="400">$400</option>
        <option value="500">$500</option>
        <option value="600">$600</option>
        <option value="700">$700</option>
        <option value="800">$800</option>
        <option value="900">$900</option>
        <option value="1000">$1,000</option>
        <option value="1500">$1,500</option>
        <option value="2000">$2,000</option>
        <option value="2500">$2,500</option>
        <option value="3000">$3,000</option>
        <option value="3500">$3,500</option>
        <option value="4000">$4,000</option>
        <option value="4500">$4,500</option>
        <option value="5000">$5,000</option>
        <option value="5500">$5,500</option>
        <option value="6000">$6,000</option>
        <option value="6500">$6,500</option>
        <option value="7000">$7,000</option>
        <option value="7500">$7,500</option>
        <option value="8000">$8,000</option>
        <option value="8500">$8,500</option>
        <option value="9000">$9,000</option>
        <option value="9500">$9,500</option>
        <option value="10000">$10,000</option>
        <option value="11000">$11,000</option>
        <option value="12000">$12,000</option>
        <option value="13000">$13,000</option>
        <option value="14000">$14,000</option>
        <option value="15000">$15,000</option>
        <option value="16000">$16,000</option>
        <option value="17000">$17,000</option>
        <option value="18000">$18,000</option>
        <option value="19000">$19,000</option>
        <option value="20000">$20,000</option>
        <option value="25000">$25,000</option>
        <option value="30000">$30,000</option>
        <option value="35000">$35,000</option>
        <option value="40000">$40,000</option>
        <option value="45000">$45,000</option>
        <option value="50000">$50,000</option>
      </select>
    </div>
    <div class="col-md-6 contact-name form-col">
      <select name="loan_purpose" id="Loan_Purpose" class="form-control" required="">
        <option value="">Loan Purpose:</option>
        <option value="Debt consolidation">Debt consolidation</option>
        <option value="Emergency situation">Emergency situation</option>
        <option value="Auto repair">Auto repair</option>
        <option value="Auto purchase">Auto purchase</option>
        <option value="Moving">Moving</option>
        <option value="Home improvement">Home improvement</option>
        <option value="Medical">Medical</option>
        <option value="Business">Business</option>
        <option value="Vacation">Vacation</option>
        <option value="Taxes">Taxes</option>
        <option value="Rent/Mortgage">Rent/Mortgage</option>
        <option value="Wedding">Wedding</option>
        <option value="Major purchase">Major purchase</option>
        <option value="Education">Education</option>
        <option value="Other">Other</option>
      </select>
    </div>
    <div class="col-md-6 contact-name form-col">
      <input name="first_name" id="first_name" class="form-control" type="text" placeholder="First Name:*" onfocus="this.placeholder=''" onblur="this.placeholder='First Name:*'" required="">
    </div>
    <div class="col-md-6 contact-email form-col">
      <input name="last_name" id="last_name" class="form-control" type="text" placeholder="Last Name:*" onfocus="this.placeholder=''" onblur="this.placeholder='Last Name*'" required="">
    </div>
    <div class="col-md-6 contact-name form-col">
      <input type="hidden" id="remarketing_phone" name="remarketing_phone" value="yes">
      <input name="phone_home" onkeypress="return (event.charCode == 8 || event.charCode == 0 || event.charCode == 13) ? null : event.charCode >= 48 &amp;&amp; event.charCode <= 57" id="phone_home" class="form-control" type="text"
        placeholder="Home Phone:*" onfocus="this.placeholder=''" onblur="this.placeholder='Home Phone:*'" oninput="javascript: if (this.value.length > this.maxLength) this.value = this.value.slice(0, this.maxLength);" maxlength="10" minlength="10"
        data-field="phone_home" data-rule-required="true" required="required">
    </div>
    <div class="col-md-6 contact-name form-col">
      <input name="phone_cell" onkeypress="return (event.charCode == 8 || event.charCode == 0 || event.charCode == 13) ? null : event.charCode >= 48 &amp;&amp; event.charCode <= 57" id="phone_cell" class="form-control" type="text"
        placeholder="Cell Phone:*" onfocus="this.placeholder=''" onblur="this.placeholder='Cell Phone:*'" oninput="javascript: if (this.value.length > this.maxLength) this.value = this.value.slice(0, this.maxLength);" maxlength="10" minlength="10"
        data-field="phone_home" data-rule-required="true" required="required">
    </div>
    <div class="col-md-6 contact-name form-col">
      <input name="email_address" id="email_address" class="form-control" type="text" placeholder="Email:*" onfocus="this.placeholder=''" onblur="this.placeholder='Email*'" required="">
    </div>
    <div class="col-md-6 contact-name form-col">
      <select name="best_time_to_call" id="Best_Time_to_Contact" class="form-control" required="">
        <option value="">Best Time to Contact:</option>
        <option value="Anytime">Anytime</option>
        <option value="Morning">Morning</option>
        <option value="Afternoon">Afternoon</option>
        <option value="Evening">Evening</option>
      </select>
    </div>
    <div class="col-md-6 contact-name form-col">
      <input name="address" id="address" class="form-control" type="text" placeholder="Address:*" onfocus="this.placeholder=''" onblur="this.placeholder='Address*'" required="">
    </div>
    <div class="col-md-6 contact-name form-col">
      <input name="address2" id="address2" class="form-control" type="text" placeholder="Address 2" onfocus="this.placeholder=''" onblur="this.placeholder='Address 2:'">
    </div>
    <div class="col-md-6 contact-name form-col">
      <input name="zip_code" onkeypress="return (event.charCode == 8 || event.charCode == 0 || event.charCode == 13) ? null : event.charCode >= 48 &amp;&amp; event.charCode <= 57" id="zip_code" class="form-control" type="text"
        placeholder="Zip Code:*" onfocus="this.placeholder=''" onblur="this.placeholder='Zip Code:*'" oninput="javascript: if (this.value.length > this.maxLength) this.value = this.value.slice(0, this.maxLength);" maxlength="5" minlength="5"
        data-field="zip_code" data-rule-required="true" required="required">
    </div>
    <div class="col-md-6 contact-name form-col">
      <input name="city" id="city" class="form-control" type="text" placeholder="City:*" onfocus="this.placeholder=''" onblur="this.placeholder='City*'" required="">
    </div>
    <div class="col-md-6">
      <select name="state" id="State" class="form-control" required="">
        <option value="">State:</option>
        <option value="AL">Alabama</option>
        <option value="AK">Alaska</option>
        <option value="AZ">Arizona</option>
        <option value="AR">Arkansas</option>
        <option value="CA">California</option>
        <option value="CO">Colorado</option>
        <option value="CT">Connecticut</option>
        <option value="DE">Delaware</option>
        <option value="DC">District Of Columbia</option>
        <option value="FL">Florida</option>
        <option value="GA">Georgia</option>
        <option value="HI">Hawaii</option>
        <option value="ID">Idaho</option>
        <option value="IL">Illinois</option>
        <option value="IN">Indiana</option>
        <option value="IA">Iowa</option>
        <option value="KS">Kansas</option>
        <option value="KY">Kentucky</option>
        <option value="LA">Louisiana</option>
        <option value="ME">Maine</option>
        <option value="MD">Maryland</option>
        <option value="MA">Massachusetts</option>
        <option value="MI">Michigan</option>
        <option value="MN">Minnesota</option>
        <option value="MS">Mississippi</option>
        <option value="MO">Missouri</option>
        <option value="MT">Montana</option>
        <option value="NE">Nebraska</option>
        <option value="NV">Nevada</option>
        <option value="NM">New Mexico</option>
        <option value="NH">New Hampshire</option>
        <option value="NJ">New Jersey</option>
        <option value="NY">New York</option>
        <option value="NC">North Carolina</option>
        <option value="ND">North Dakota</option>
        <option value="OH">Ohio</option>
        <option value="OK">Oklahoma</option>
        <option value="OR">Oregon</option>
        <option value="PA">Pennsylvania</option>
        <option value="RI">Rhode Island</option>
        <option value="SC">South Carolina</option>
        <option value="SD">South Dakota</option>
        <option value="TN">Tennessee</option>
        <option value="TX">Texas</option>
        <option value="UT">Utah</option>
        <option value="VT">Vermont</option>
        <option value="VA">Virginia</option>
        <option value="WA">Washington</option>
        <option value="WV">West Virginia</option>
        <option value="WI">Wisconsin</option>
        <option value="WY">Wyoming</option>
      </select>
    </div>
    <div class="col-md-12">
      <br><br>
      <center><label for="dob">
          <h4>Your Date Of Birth</h4>
        </label></center>
      <br><br>
    </div>
    <input id="dob" hidden="" name="dob">
    <div class="col-md-4">
      <select name="day" class="form-control" onchange="getDate()" id="day" data-msg-required="Add Day" data-rule-required="true" required="required">
        <option value="" disabled="" selected="">Day</option>
        <option value="01">01</option>
        <option value="02">02</option>
        <option value="03">03</option>
        <option value="04">04</option>
        <option value="05">05</option>
        <option value="06">06</option>
        <option value="07">07</option>
        <option value="08">08</option>
        <option value="09">09</option>
        <option value="10">10</option>
        <option value="11">11</option>
        <option value="12">12</option>
        <option value="13">13</option>
        <option value="14">14</option>
        <option value="15">15</option>
        <option value="16">16</option>
        <option value="17">17</option>
        <option value="18">18</option>
        <option value="19">19</option>
        <option value="20">20</option>
        <option value="21">21</option>
        <option value="22">22</option>
        <option value="23">23</option>
        <option value="24">24</option>
        <option value="25">25</option>
        <option value="26">26</option>
        <option value="27">27</option>
        <option value="28">28</option>
        <option value="29">29</option>
        <option value="30">30</option>
        <option value="31">31</option>
      </select>
    </div>
    <script>
      document.addEventListener("DOMContentLoaded", function(event) {
        var selectBox = document.getElementById('day');
        for (var i = 1; i <= 31; i++) {
          if (i < 10) {
            i = '0' + i;
          }
          var option = document.createElement('option');
          option.value = i;
          option.innerHTML = i;
          selectBox.appendChild(option);
        }
      });
    </script>
    <div class="col-md-4">
      <select name="month" class="form-control" onchange="getDate()" id="dobmonth" data-msg-required="Add month" data-rule-required="true" required="required">
        <option value="" disabled="" selected="">Month</option>
        <option value="01">January</option>
        <option value="02">February</option>
        <option value="03">March</option>
        <option value="04">April</option>
        <option value="05">May</option>
        <option value="06">June</option>
        <option value="07">July</option>
        <option value="08">August</option>
        <option value="09">September</option>
        <option value="10">October</option>
        <option value="11">November</option>
        <option value="12">December</option>
      </select>
    </div>
    <div class="col-md-4">
      <select name="year" class="form-control" onchange="getDate()" id="year" data-msg-required="Add year" data-rule-required="true" required="required">
        <option value="" disabled="" selected="">Year</option>
        <option value="2003">2003</option>
        <option value="2002">2002</option>
        <option value="2001">2001</option>
        <option value="2000">2000</option>
        <option value="1999">1999</option>
        <option value="1998">1998</option>
        <option value="1997">1997</option>
        <option value="1996">1996</option>
        <option value="1995">1995</option>
        <option value="1994">1994</option>
        <option value="1993">1993</option>
        <option value="1992">1992</option>
        <option value="1991">1991</option>
        <option value="1990">1990</option>
        <option value="1989">1989</option>
        <option value="1988">1988</option>
        <option value="1987">1987</option>
        <option value="1986">1986</option>
        <option value="1985">1985</option>
        <option value="1984">1984</option>
        <option value="1983">1983</option>
        <option value="1982">1982</option>
        <option value="1981">1981</option>
        <option value="1980">1980</option>
        <option value="1979">1979</option>
        <option value="1978">1978</option>
        <option value="1977">1977</option>
        <option value="1976">1976</option>
        <option value="1975">1975</option>
        <option value="1974">1974</option>
        <option value="1973">1973</option>
        <option value="1972">1972</option>
        <option value="1971">1971</option>
        <option value="1970">1970</option>
        <option value="1969">1969</option>
        <option value="1968">1968</option>
        <option value="1967">1967</option>
        <option value="1966">1966</option>
        <option value="1965">1965</option>
        <option value="1964">1964</option>
        <option value="1963">1963</option>
        <option value="1962">1962</option>
        <option value="1961">1961</option>
        <option value="1960">1960</option>
        <option value="1959">1959</option>
        <option value="1958">1958</option>
        <option value="1957">1957</option>
        <option value="1956">1956</option>
        <option value="1955">1955</option>
        <option value="1954">1954</option>
        <option value="1953">1953</option>
        <option value="1952">1952</option>
        <option value="1951">1951</option>
        <option value="1950">1950</option>
        <option value="1949">1949</option>
        <option value="1948">1948</option>
        <option value="1947">1947</option>
        <option value="1946">1946</option>
        <option value="1945">1945</option>
        <option value="1944">1944</option>
        <option value="1943">1943</option>
        <option value="1942">1942</option>
        <option value="1941">1941</option>
        <option value="1940">1940</option>
        <option value="1939">1939</option>
        <option value="1938">1938</option>
      </select>
    </div>
    <script>
      document.addEventListener("DOMContentLoaded", function(event) {
        var selectBox = document.getElementById('year');
        for (var i = 2003; i >= 1938; i--) {
          var option = document.createElement('option');
          option.value = i;
          option.innerHTML = i;
          selectBox.appendChild(option);
        }
      });
    </script>
    <script>
      function getDate() {
        var day = document.getElementById("day").value;
        var month = document.getElementById("dobmonth").value;
        var year = document.getElementById("year").value;
        var date = year + "-" + month + "-" + day;
        console.log(date);
        document.getElementById("dob").value = date;
        // console.log(document.getElementById("newDate").value);
        console.log(document.getElementById("dob").value);
      }
    </script>
    <div class="col-md-12">
      <br><br>
      <center>
        <h1>A Few More Details</h1>
      </center>
      <br><br>
    </div>
    <div class="col-md-6">
      <select name="military" id="is-military" class="form-control" required="">
        <option value="">Active Military (or dependent)?</option>
        <option value="true">Yes</option>
        <option value="false">No</option>
      </select>
    </div>
    <div class="col-md-6">
      <select name="own_home" id="own_home" class="form-control" required="">
        <option value="">Home Ownership:</option>
        <option value="own">Own</option>
        <option value="rent">Rent</option>
      </select>
    </div>
    <div class="col-md-6"><br>
      <select name="month_at_address" id="month" class="form-control" required="">
        <option value="">Months at Residence:</option>
        <option value="3">3 Months</option>
        <option value="6">6 Months</option>
        <option value="9">9 Months</option>
        <option value="12">12 Months</option>
        <option value="18">18 Months</option>
        <option value="24">24 Months</option>
        <option value="36">36 Months</option>
        <option value="48">48 Months</option>
        <option value="60">60 Months</option>
      </select>
    </div>
    <div class="col-md-6"><br>
      <select name="pay_frequency" id="pay_frequency_ee8" class="form-control" required="">
        <option value="">Pay Frequency:</option>
        <option value="Weekly">Weekly</option>
        <option value="Biweekly">Biweekly</option>
        <option value="Semimonthly">Twicemonthly</option>
        <option value="Monthly">Monthly</option>
      </select>
    </div>
    <div class="col-md-6"><br>
      <select name="monthly_income" id="Monthly_Income" class="form-control" required="">
        <option value="">Monthly Income:</option>
        <option value="1000">$1,000</option>
        <option value="1500">$1,500</option>
        <option value="2000">$2,000</option>
        <option value="2500">$2,500</option>
        <option value="3000">$3,000</option>
        <option value="3500">$3,500</option>
        <option value="4000">$4,000</option>
        <option value="4500">$4,500</option>
        <option value="5000">$5,000</option>
      </select>
    </div>
    <div class="col-md-6"><br>
      <select name="income_type" id="Income_Type" class="form-control" required="">
        <option value="">Income Type:</option>
        <option value=" Self-employed">Self-employed</option>
        <option value="Benefits">Benefits</option>
        <option value="Employment">Employment</option>
      </select>
    </div>
    <div class="col-md-6"><br>
      <select name="credit_score" id="credit_score" class="form-control" required="">
        <option value="">Credit Score:</option>
        <option value="600-649">Poor (500 and Below)</option>
        <option value="650-699">Fair (500-599)</option>
        <option value="700-749">Good (600-699)</option>
        <option value="750+">Excellent (700+)</option>
      </select>
    </div>
    <div class="col-md-6"><br>
      <select name="drivers_license_state" id="drivers_license_state" class="form-control" required="">
        <option value="">Driver`s License State:</option>
        <option value="AL">Alabama</option>
        <option value="AK">Alaska</option>
        <option value="AZ">Arizona</option>
        <option value="AR">Arkansas</option>
        <option value="CA">California</option>
        <option value="CO">Colorado</option>
        <option value="CT">Connecticut</option>
        <option value="DE">Delaware</option>
        <option value="DC">District Of Columbia</option>
        <option value="FL">Florida</option>
        <option value="GA">Georgia</option>
        <option value="HI">Hawaii</option>
        <option value="ID">Idaho</option>
        <option value="IL">Illinois</option>
        <option value="IN">Indiana</option>
        <option value="IA">Iowa</option>
        <option value="KS">Kansas</option>
        <option value="KY">Kentucky</option>
        <option value="LA">Louisiana</option>
        <option value="ME">Maine</option>
        <option value="MD">Maryland</option>
        <option value="MA">Massachusetts</option>
        <option value="MI">Michigan</option>
        <option value="MN">Minnesota</option>
        <option value="MS">Mississippi</option>
        <option value="MO">Missouri</option>
        <option value="MT">Montana</option>
        <option value="NE">Nebraska</option>
        <option value="NV">Nevada</option>
        <option value="NM">New Mexico</option>
        <option value="NH">New Hampshire</option>
        <option value="NJ">New Jersey</option>
        <option value="NM">New Mexico</option>
        <option value="NY">New York</option>
        <option value="NC">North Carolina</option>
        <option value="ND">North Dakota</option>
        <option value="OH">Ohio</option>
        <option value="OK">Oklahoma</option>
        <option value="OR">Oregon</option>
        <option value="PA">Pennsylvania</option>
        <option value="RI">Rhode Island</option>
        <option value="SC">South Carolina</option>
        <option value="SD">South Dakota</option>
        <option value="TN">Tennessee</option>
        <option value="TX">Texas</option>
        <option value="UT">Utah</option>
        <option value="VT">Vermont</option>
        <option value="VA">Virginia</option>
        <option value="WA">Washington</option>
        <option value="WV">West Virginia</option>
        <option value="WI">Wisconsin</option>
        <option value="WY">Wyoming</option>
      </select>
    </div>
    <div class="col-md-6 contact-name form-col"><br>
      <input name="drivers_license_number" id="drivers_license_number" class="form-control" type="text" placeholder="Driving License Number" onfocus="this.placeholder=''" data-rule-required="true" required="required"
        onblur="this.placeholder='Driving License Number:'">
    </div>
    <div class="col-md-6 contact-name form-col"><br>
      <input name="ssn" onkeypress="return (event.charCode == 8 || event.charCode == 0 || event.charCode == 13) ? null : event.charCode >= 48 &amp;&amp; event.charCode <= 57" id="ssn" class="form-control" type="text" placeholder="SSN:*"
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    <div class="col-md-12">
      <br><br>
      <center>
        <h1>Employment Details</h1>
      </center>
      <br><br>
    </div>
    <div class="col-md-6 contact-name form-col"><br>
      <input name="employer" id="employer" class="form-control" type="text" placeholder="Employer Name:*" onfocus="this.placeholder=''" data-rule-required="true" required="required" onblur="this.placeholder='Employer Name:*'">
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    <div class="col-md-6 contact-name form-col"><br>
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    <div class="col-md-6">
      <select name="months_at_employer" id="months_at_employer" class="form-control" required="">
        <option value="">Months at Employer:</option>
        <option value="3">3 Months</option>
        <option value="6">6 Months</option>
        <option value="9">9 Months</option>
        <option value="12">12 Months</option>
        <option value="18">18 Months</option>
        <option value="24">24 Months</option>
        <option value="36">36 Months</option>
        <option value="48">48 Months</option>
        <option value="60">60 Months</option>
      </select>
    </div>
    <div class="row">
      <div class="col-md-6">
        <label for="next_pay_date">Next Pay Date:</label>
        <input type="date" onchange="nextpaycheck()" id="nextpaydate" min="" name="next_pay_date" data-field="next_pay_date" class="form-control" required="">
      </div>
      <div class="col-md-6">
        <label for="second_pay_date">Following Pay Date:</label>
        <input type="date" onchange="followingpaycheck()" id="followingpaydate" min="" name="following_pay_date" data-field="second_pay_date" class="form-control" required="">
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      <div class="col-md-12">
        <br><br>
        <center>
          <h1>Bank Details</h1>
        </center>
        <br><br>
      </div>
      <div class="col-md-6 contact-name form-col">
        <input name="bank_name" id="bank_name" class="form-control" type="text" placeholder="Bank Name:*" onfocus="this.placeholder=''" data-rule-required="true" required="required" onblur="this.placeholder='Bank Name:*'">
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      <div class="col-md-6 contact-name form-col">
        <input name="bank_phone" onkeypress="return (event.charCode == 8 || event.charCode == 0 || event.charCode == 13) ? null : event.charCode >= 48 &amp;&amp; event.charCode <= 57" id="bank_phone" class="form-control" type="text"
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          data-field="bank_phone" data-rule-required="true" required="required">
      </div>
      <div class="col-md-12">
        <center><img src="img/samplecheck.png" alt="Sample Check"></center>
        <br>
      </div>
      <div class="col-md-6 contact-name form-col">
        <input name="account_number" onkeypress="return (event.charCode == 8 || event.charCode == 0 || event.charCode == 13) ? null : event.charCode >= 48 &amp;&amp; event.charCode <= 57" id="account_number" class="form-control" type="text"
          placeholder="Account Number:*" data-rule-required="true" required="required">
      </div>
      <div class="col-md-6 contact-name form-col">
        <input name="routing_number" onkeypress="return (event.charCode == 8 || event.charCode == 0 || event.charCode == 13) ? null : event.charCode >= 48 &amp;&amp; event.charCode <= 57" id="routing_number" class="form-control" type="text"
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          minlength="9" data-field="routing_number" data-rule-required="true" required="required">
      </div>
      <div class="col-md-6">
        <select name="account_type" id="account_type" class="form-control" required="">
          <option value="">Bank Account Type:</option>
          <option value="Checking">Checking</option>
          <option value="Saving">Saving</option>
        </select>
      </div>
      <div class="col-md-6">
        <select name="account_length" id="account_length" class="form-control" required="">
          <option value="">Months at Bank:</option>
          <option value="3">3 Months</option>
          <option value="6">6 Months</option>
          <option value="9">9 Months</option>
          <option value="12">12 Months</option>
          <option value="18">18 Months</option>
          <option value="24">24 Months</option>
          <option value="36">36 Months</option>
          <option value="48">48 Months</option>
          <option value="60">60 Months</option>
          <option value="72">72 Months</option>
          <option value="84">84 Months</option>
          <option value="96">96 Months</option>
          <option value="108">108 Months</option>
          <option value="120">120 Months</option>
          <option value="120">More Than 10 Years</option>
        </select>
      </div>
      <div class="col-md-6"><br>
        <select name="direct_deposit" id="direct_deposit" class="form-control" required="">
          <option value="">Direct Deposit:</option>
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
      </div>
      <div class="col-md-12">
        <br><br>
        <center>
          <h1>Title Loan</h1>
        </center>
        <br><br>
      </div>
      <div class="col-md-12"><br>
        <center><label>Do you have a vehicle registered in your name?</label>
          <select name="title_loan_type" id="title_loan_type" class="form-control" required="">
            <option value="">Select</option>
            <option value="No">No</option>
            <option value="Yes It's Paid Off">Yes It's Paid Off</option>
            <option value="Yes Making Payments">Yes Making Payments</option>
          </select>
        </center>
      </div>
      <div class="col-md-12"><br>
        <label> <input type="checkbox" id="leadid_tcpa_disclosure" name="tcpa_consent" value="yes" required=""> I certify I am a US Resident, Age 18+. I have read &amp; agree to the Disclaimer,
          <a href="privacy_policy.html" target="_blank">Privacy Policy</a>, <a href="tandcs.html" target="_blank">Terms &amp; Terms of Use</a>, and <a href="e-consent.html" target="_blank">E-consent</a>. I authorize ABCashNow.com to share my
          information with lenders, lending partners, and marketing partners and for these parties to use my information to obtain consumer report information on my credit profile. I also give express written consent to receive recurring
          communications from them and ABCashNow.com, including live, autodialed and prerecorded text messages (SMS), emails, and calls regarding my request and related services at the number provided even if my number is on the state/federal
          Do-Not-Call list. I understand that my consent to receive communications is not required to use this Site’s services and <a href="partners.html">partners</a> of ABCashNow.com, I understand that providing consent to be contacted is not a
          condition to purchase any good or service.</label>
      </div>
      <div class="col-md-12"><br>
        <label><input type="checkbox" id="remarketing_sms" name="remarketing_sms" value="yes" required="">
          <i></i> I consent to receive telephone calls (including SMS text messages)</label>
      </div>
      <div class="col-md-12"><br>
        <label><input type="checkbox" id="remarketing_email" name="remarketing_email" value="yes" required="">
          <i></i> (This message is not a condition to obtaining a loan or any services).<br> Please be patient. It may take up to 180 seconds to process your loan request.</label>
      </div>
      <center><input onclick="jadu()" id="jaduu" type="submit" value="Submit Form" class="primary-btn"></center>
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</form>

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ABCashNow.com

REQUEST FORM

BASIC DETAILS

Loan Amount: $100 $200 $300 $400 $500 $600 $700 $800 $900 $1,000 $1,500 $2,000
$2,500 $3,000 $3,500 $4,000 $4,500 $5,000 $5,500 $6,000 $6,500 $7,000 $7,500
$8,000 $8,500 $9,000 $9,500 $10,000 $11,000 $12,000 $13,000 $14,000 $15,000
$16,000 $17,000 $18,000 $19,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000
$50,000
Loan Purpose: Debt consolidation Emergency situation Auto repair Auto purchase
Moving Home improvement Medical Business Vacation Taxes Rent/Mortgage Wedding
Major purchase Education Other

Best Time to Contact: Anytime Morning Afternoon Evening

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware
District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Mexico New Hampshire New Jersey New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming

YOUR DATE OF BIRTH

Day 01020304050607080910111213141516171819202122232425262728293031
Month January February March April May June July August September October
November December
Year
200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938

A FEW MORE DETAILS

Active Military (or dependent)? Yes No
Home Ownership: Own Rent

Months at Residence: 3 Months 6 Months 9 Months 12 Months 18 Months 24 Months 36
Months 48 Months 60 Months

Pay Frequency: Weekly Biweekly Twicemonthly Monthly

Monthly Income: $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500 $5,000

Income Type: Self-employed Benefits Employment

Credit Score: Poor (500 and Below) Fair (500-599) Good (600-699) Excellent
(700+)

Driver`s License State: Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois
Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan
Minnesota Mississippi Missouri Montana Nebraska Nevada New Mexico New Hampshire
New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon
Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah
Vermont Virginia Washington West Virginia Wisconsin Wyoming

EMPLOYMENT DETAILS

Months at Employer: 3 Months 6 Months 9 Months 12 Months 18 Months 24 Months 36
Months 48 Months 60 Months
Next Pay Date:
Following Pay Date:

BANK DETAILS

Bank Account Type: Checking Saving
Months at Bank: 3 Months 6 Months 9 Months 12 Months 18 Months 24 Months 36
Months 48 Months 60 Months 72 Months 84 Months 96 Months 108 Months 120 Months
More Than 10 Years

Direct Deposit: Yes No

TITLE LOAN

Do you have a vehicle registered in your name? Select No Yes It's Paid Off Yes
Making Payments

I certify I am a US Resident, Age 18+. I have read & agree to the Disclaimer,
Privacy Policy, Terms & Terms of Use, and E-consent. I authorize ABCashNow.com
to share my information with lenders, lending partners, and marketing partners
and for these parties to use my information to obtain consumer report
information on my credit profile. I also give express written consent to receive
recurring communications from them and ABCashNow.com, including live, autodialed
and prerecorded text messages (SMS), emails, and calls regarding my request and
related services at the number provided even if my number is on the
state/federal Do-Not-Call list. I understand that my consent to receive
communications is not required to use this Site’s services and partners of
ABCashNow.com, I understand that providing consent to be contacted is not a
condition to purchase any good or service.

I consent to receive telephone calls (including SMS text messages)

(This message is not a condition to obtaining a loan or any services).
Please be patient. It may take up to 180 seconds to process your loan request.

* PLEASE DON’T LEAVE THIS PAGE WHILE YOUR REQUEST IS PROCESSING!

* IF INTERRUPTED, THE PROCESS LIKELY TO FAIL.

* We are currently searching our extensive database to ensure you are matched
with a lender that meets your needs. You will be redirected to your lender
upon completion.
We are not a lender. We will connect you with you lender shortly.
* If you want to cancel your application, you need to wait till you are
redirected to a lender’s website. You are never obligated to accept any
offer!
* Once you are redirected, you can either accept a loan by putting your
e-signature or cancel application.

MATERIAL DISCLOSURE

APR Disclosure. Some states have laws limiting the Annual Percentage Rate (APR)
that a lender can charge you. APRs for cash advance loans range from 200% to
1386%, APRs for installment loans range from 6.63% to 485%, and APRs for
personal loans range from 4.99% to 450% and vary by lender. Loans from a state
that has no limiting laws or loans from a bank not governed by state laws may
have an even higher APR. The APR is the rate at which your loan accrues interest
and is based upon the amount, cost and term of your loan, repayment amounts and
timing of payments. Lenders are legally required to show you the APR and other
terms of your loan before you execute a loan agreement. APR rates are subject to
change.

Material Disclosure. The operator of this website is not a lender, loan broker
or agent for any lender or loan broker. We are an advertising referral service
to qualified participating lenders that may be able to provide amounts between
$100 and $1,000 for cash advance loans, up to $5,000 for installment loans, and
up to $35,000 for personal loans. Not all lenders can provide these amounts and
there is no guarantee that you will be accepted by an independent, participating
lender. This service does not constitute an offer or solicitation for loan
products which are prohibited by any state law. This is not a solicitation for a
particular loan and is not an offer to lend. We do not endorse or charge you for
any service or product. Any compensation received is paid by participating
lenders and only for advertising services provided. This service and offer are
void where prohibited. We do not control and are not responsible for the actions
of any lender. We do not have access to the full terms of your loan, including
APR. For details, questions or concerns regarding your loan please contact your
lender directly. Only your lender can provide you with information about your
specific loan terms, their current rates and charges, renewal, payments and the
implications for non-payment or skipped payments. The registration information
submitted by you on this website will be shared with one or more participating
lenders. You are under no obligation to use our service to initiate contact with
a lender, register for credit or any loan product, or accept a loan from a
participating lender. Cash transfer times and repayment terms vary between
lenders. Repayment terms may be regulated by state and local laws. Some faxing
may be required. Be sure to review our FAQs for additional information on issues
such as credit and late payment implications. These disclosures are provided to
you for information purposes only and should not be considered legal advice. Use
of this service is subject to this site’s Terms of Use and Privacy Policy.

Exclusions. Residents of some states may not be eligible for some or all
short-term, small-dollar loans. Residents of Arkansas, New York, Vermont and
West Virginia are not eligible to use this website or service. The states
serviced by this website may change from time to time, without notice.

Credit Implications. The operator of this website does not make any credit
decisions. Independent, participating lenders that you might be connected with
may perform credit checks with credit reporting bureaus or obtain consumer
reports, typically through alternative providers to determine credit worthiness,
credit standing and/or credit capacity. By submitting your information, you
agree to allow participating lenders to verify your information and check your
credit. Loans provided by independent, participating lenders in our network are
designed to provide cash to you to be repaid within a short amount of time. The
short-term loans are not a solution for long-term debt and credit difficulties.
Only borrow an amount that can be repaid on the date of your next pay period.
Consider seeking professional advice regarding your financial needs, risks and
alternatives to short-term loans. Late Payments of loans may result in
additional fees or collection activities, or both. Each lender has their own
terms and conditions, please review their policies for further information.
Nonpayment of credit could result in collection activities. Every lender has its
own renewal policy, which may differ from lender to lender. Please review your
lender’s renewal policy.

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* Do Not Sell My Personal Information

* Rates and Fees
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