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CUSTOMER INFORMATION Información de solicitante

          First Name
          Primer nombre
          *
        
          Last Name
          Apellido
          *
        
          SSN
          SSN
          
          *
          
             -  - 
          
  -  - 
        
            E-mail
            Correo electrónico
            
            *
            
            Birth Date
            Fecha de nacimiento
            
            *
            
          Valid Driver's License or State ID Number
          Numero de licencia
          
          State Issued
          Estado
          
            Home Phone
            Teléfono de casa
            
            Cell Phone
            Numero de celular
            
            *
            
            Best Time To Call
            La mejor hora de contacto
            
            Address
            Dirección
            
            *
            
            City
            Ciudad
            
            *
            
            State
            Estado
            
            *
            
            Zip
            Código postal
            
            *
            
            Time At Address
            Tiempo en residencia
            
            Own/Rent
            Esta rentando o poseeуn
            
              RentOwn

BANKING INFORMATION Información bancaria

Other bank account Other bank account

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DEBIT/CREDIT CARD INFORMATION

Name On Card

Billing Address

Card Number

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City

Exp Date

State

Zip

INCOME & EMPLOYMENT INFORMATION Ingresos y empleo información

Income from alimony, child support or separate maintenance payments need not be disclosed if you don't wish us to consider this as a source of repayment. Ingresos por manutención de menores o pensión matrimonial u otros ingresos no es necesario declarar esta información si no va hacer utilizado como forma de pago.

Other Income Otro tipo de saldo

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MILITARY Militar

Federal law provides important protections to active duty members of the Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, we require you to sign one of the following statements as applicable: La ley federal ofrece protections importantes a los miembros activos de las fuerzas armadas y sus dependientes. Para aseguramos de que estas protectiones sean dadas a aplicantes elegibles, requerimos que firme una de las siguientes lineas:

Yes

I AM a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer.

Soy un miembro de la reserva de las fuerzas armadas, fuerza naval, cuerpo marinos, fuerza aerea o guarda costera sirviendo actualmente segun sea requerido u orden que no especifica un periodo de 30 dias o mas.

- or -

I AM a dependent of a member of the Armed Forces on active duty as described above, because I am the member's spouse, the member's child under the age of eighteen years old, or I am an individual for whom the member provided more than one-half of my financial support for 180 days immediately preceding today's date.

Soy un dependiente de un miembro de las Fuerzas Armadas sirviendo actualmente como lo explique arriba porque soy esposa (o) de un miembro, el hijo del miembro es menor de dieciocho años, o un sujeto para quien el miembro le mas de la mitad de apoyo financiero por 180 dias a partir de hoy.

I AM NOT a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer (or a dependent of such a member).

No soy un miembro de la reserva de las fuerzas armadas, fuerza naval, cuerpo marinos, fuerza aerea o guarda costera sirviendo actualmente segun sea requerido u orden que no especifica un periodo de 30 dias o mas (o un dependiente de tal miembro).

TEXT MESSAGE COMMUNICATION Comunicados mediante mensaje de texto

Yes, please send me account-related messages such as payment reminders to the cell phone number provided

Sí, envíeme mensajes relacionados con la cuenta, como recordatorios de pago, al número de teléfono celular proporcionado

By checking the above, you are opting in to receive SMS text messages from PG Test. Message and data rates may apply. Message frequency will vary. To opt-out at any time, reply STOP to any message we send, or HELP for more information. Al marcar lo anterior, usted opta por recibir mensajes de texto SMS de PG Test. Se pueden aplicar tarifas por mensajes y datos. La frecuencia de los mensajes variará. Para cancelar su participación en cualquier momento, responda DETENER a cualquier mensaje que le enviemos o AYUDA para obtener más información. Texto

ADVERTISING PUBLICIDAD

How did you hear about us? Como se entero de nosotros?

Details

To monitor and manage your account, please create a user name and password. Para controlar y manejar su cuenta, favor de crear un nombre usuario y contraseña. (Username and Password require a minimum of 4 characters.) (Usuario y contraseña requiera un mínimo de 4 letras o símbolos)

User Name Nombre de usuario *

Password Contraseña *

Repeat Password Repita contraseña *

Atoske, LLC is a tribal lender of the Chippewa Cree Tribe operating within the boundaries of the Rocky Boy’s Indian Reservation, Montana, a sovereign nation located within the United States of America. Loans from Atoske are governed by the laws of the Chippewa Cree Tribe, not the law of your resident state. The laws of your resident state may have interest rate limits and other consumer protection provisions that are more favorable. If you wish to have your resident state law apply, you should consider taking a loan from a licensed lender in your state.

This is an expensive form of credit. Alternative forms of credit, such as a credit card cash advance, personal loan, home equity line of credit, existing savings or borrowing from a friend or relative, may be less expensive and more suitable for your financial needs. Before borrowing, please consider whether you will be able to repay any amount you borrow along with the interest charges disclosed to you in your loan agreement. Customers with continued credit difficulties should seek credit counseling.

Refinancing may be available and is not automatic. Refinancing your loan will extend the term of the loan and result in additional interest charges. Late fees and non-sufficient funds/returned item fees may apply as described in your Loan Agreement. We will never charge you any "hidden fees" that are not fully disclosed in the Loan Agreement or the Loan Cost & Terms. If you don't make a payment on time we will attempt to contact you via one or more authorized methods. We adhere to the principles of the federal Fair Debt Collection Practices Act (FDCPA).

Because we may report your payment history to one or more credit bureaus, late or non-payment of your loan may negatively impact your credit rating. If you fail to repay your loan in accordance with its terms, we may place your loan with or sell your loan to a third-party collection agency or other company that acquires and/or collects delinquent consumer debt. 1First-time Atoske customers typically qualify for an installment loan of $500 to $1,000, with an APR of 299.17% to 373.97%. A $700 loan from Atoske Loans would require 14 bi-weekly installments of $116.63, including $932.70 of interest and an APR of 364.00%. After the 14th successful payment, your loan would be paid in full. Refer to Loan Cost & Terms for additional details.

*In most cases, applications that are received and can be verified prior to 6:00 p.m. Eastern Time (Monday - Friday) will be funded the next business banking day (excluding weekends and bank holidays). Applications received after 6:00 p.m. Eastern Time (Monday - Friday) may require an additional business banking day to fund. In some cases, we may not be able to verify your application information and may