UNA SOLICITUD DE PRESTAMO EN ENSPANOL ESTA DISPONIBLE A SOLICITUD.

LOAN APPLICATION

County Bank of Rehoboth Beach, Delaware
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.  What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying document.

NOTICE: WE ARE REQUIRED BY LAW TO ADOPT PROCEDURES TO REQUEST AND RETAIN IN OUR RECORDS INFORMATION NECESSARY TO VERIFY YOUR IDENTITY.

YOU MAY BE APPROVED FOR UP TO $1,000 IF YOU MEET THESE SIMPLE REQUIREMENTS
Loans are not currently available in Georgia, Idaho, Delaware and W. Virginia

1. You must have a steady income.
2. You must be able to show a verifiable source of recurring income payments.
3. You must have a direct deposit checking account with your name printed on the checks.
4. You must be able to be contacted after work.
5. You must be at least 18 years old
6. You must have a gross income of at least $1250 per month, or a minimum of $1000 per month in Social Security or other benefits income.
7. You must not be delinquent on a prior loan from County Bank or other short term lender.
8. You must have access to a fax machine.
9. You must not currently in bankruptcy case or presently intend to voluntarily file for bankruptcy relief.
10. You must reside in a state where the residents are eligible for County Bank's loans. 

COMPLETE ALL THE FOLLOWING INFORMATION

PLEASE FILL OUT ALL INFORMATION
FAX THE FOLLOWING
   Pages 2 And 3 of this Application
   Blank Voided Personal Check
   Most Recent Pay Stub showing Year to Date Income
   Most Recent Bank Statement
 
 
Fax to 800-510-0799
 

 

Current Personal Information

Name: 

Phone:
Residence Address: 
City: State: Zip:
How long have you lived at this address?
 Months Years Rent  Own		 Phone number where we can send you a Fax?
Social Security Number: -- -- Birth Date: (mm/dd/year) / /
Are you currently a debtor in a bankruptcy case or you are planning on to file for bankruptcy relief?  Yes  No
Driver's License Number: State: 
How did you hear about us? E-mail address:

Current Work and Bank Information

Employer:

 Phone: 
Address: Your Extension:
City: State: Zip:
How long have you worked here? Hire Date: Shift/Hours:
What is your position?
How much is your salary each pay period? *
Supervisor’s name? Supervisor's Phone:
What are your next two pay dates? 1st Pay Date: / /   2nd Pay Date: / /  
Do you have a checking account?
Yes No 		Is your paycheck deposited directly into your checking account?* Yes       No
* Or other source of income received periodically. Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a source for repaying this obligation.

2 Personal Contacts – At Least 1 Must Be A Relative Not Living With You!

Name

Phone Number

Relationship

1.
2.

 

 

A COPY OF A VOIDED CHECK, WITH YOUR NAME AND ADDRESS PREPRINTED ON THE CHECK, MUST BE ATTACHED HERE

AGREEMENT NOT TO BRING, JOIN OR PARTICIPATE IN CLASS OR CONSOLIDATED ACTIONS: To the extent permitted by law, by signing below you agree that you will not bring, join or participate in any class or consolidate action as to any claim, dispute or controversy you may have against us or our agents, servicers, directors, officers and employees.  This agreement not to bring, join or participate in class or consolidated actions is an independent agreement and shall survive the closing, funding, repayment and/or default of the loan for which you are applying.

 AGREEMENT TO ARBITRATE ALL DISPUTES: By signing below and to induce us, County of Bank of Rehoboth Beach, Delaware, to process your application for a loan, you and we agree that any and all claims, disputes or controversies that we or our servicers or agents have against you or that you have against us, our servicers, agents, directors, officers and employees, that arise out of your application for a loan, the loan for which you are applying or any other loan we previously or may later make to you, each and every refinancing of such a loan from us, the Loan Agreement and/or Note And Disclosure that governs your repayment obligations, this Agreement To Arbitrate All Disputes, regarding collection of such a loan, or alleging fraud or misrepresentation, whether under the common law or pursuant to federal or state statute or regulation, or otherwise, including disputes as to the matters subject to arbitration, shall be resolved by binding individual (and not class) arbitration by and under the Code of Procedure of the National Arbitration Forum (“NAF”) in effect at the time the claim is filed. This Agreement To Arbitrate All Disputes shall apply no matter by whom or against whom the claim is filed. Rules and forms of the NAF may be obtained and all claims shall be filed at any NAF office, on the World Wide Web at www.arb-forum.com, or at “National Arbitration Forum, P.O. Box 50191, Minneapolis, Minnesota 55405-0191.” If you are unable to pay the costs of arbitration, your arbitration fees may be waived by the NAF. You may select the person to conduct the arbitration from a list of arbitrators provided by the NAF. The cost of a participatory hearing, if one is held at your or our request, will be paid for solely by us if the amount of the claim is $15,000 or less. Unless otherwise ordered by the arbitrator, you and we agree to equally share the costs of a participatory hearing if the claim is for more than $15,000 or less than $75,000. If the claim is for $75,000 or more the costs of a participatory hearing shall be allocated in accordance with the Code of Procedure of the NAF. In all instances, each party shall pay its own attorneys' fees except as provided by law or the award of the arbitrator. Any participatory hearing will take place at a location near your residence. This arbitration agreement is made pursuant to a transaction involving interstate commerce. It shall be governed by the Federal Arbitration Act, 9 U.S.C. Sections 1-16. Judgment upon the award may be entered by any party in any court having jurisdiction. This Agreement To Arbitrate All Disputes is an independent agreement and shall survive the closing, funding, repayment and/or default of the loan for which you are applying

NOTICE: YOU AND WE WOULD HAVE HAD A RIGHT OR OPPORTUNITY TO LITIGATE DISPUTES THROUGH A COURT AND HAVE A JUDGE OR JURY DECIDE THE DISPUTES BUT HAVE AGREED INSTEAD TO RESOLVE DISPUTES THROUGH BINDING ARBITRATION.
President, County Bank
                    (Borrower's Signature to the above Agreements Appears Below)

 By signing this Application you certify that all of the information provided above is true, complete and correct and provided to us, County Bank of Rehoboth Beach, Delaware, for the purpose of inducing us to make the loan for which you are applying.  By signing below (i) you agree to the Agreement Not To Bring, Join Or Participate In Class Or Consolidated Actions and the separate Agreement To Arbitrate All Disputes above; (ii) you acknowledge receiving and reading the Application Supplement on page 3; (iii) that, should this Application be approved by us and you accept the proceeds of the loan, you agree to all of the terms of the Loan Agreement or Note And Disclosure that will be provided to you at the time we disburse the loan proceeds to you; and (iv) you authorize us to contact you at home or at work at any time up to 9:00 p.m. regarding your loan.  We have retained Advan$e Finance, Inc. to assist in processing your Application and servicing and collecting your loan.  By signing below you authorize us and Advan$e Finance, Inc. to share information in your Application and with regard to the processing, funding, servicing, repayment and collection of your loan.  This Application will be deemed incomplete and will not be processed by us unless signed by you below.
Signature_____________________Print Name___________________ Date _____/______/_____
CALL COUNTY BANK OF REHOBOTH BEACH, DELAWARE, AT  800-582-7555 WITH ANY QUESTIONS REGARDING YOUR APPLICATION.  TELEFAX PAGES 2 AND 3, WHEN COMPLETED AND SIGNED, TO 800-510-0799
 

APPLICATION SUPPLEMENT 

SHORT TERM LOANS PROVIDE THE CASH NEEDED TO MEET IMMEDIATE SHORT-TERM CASH FLOW PROBLEMS.  THEY ARE NOT A SOLUTION FOR LONGER TERM FINANCIAL PROBLEMS FOR WHICH OTHER KINDS OF FINANCING (SUCH AS CREDIT CARDS, AN OVERDRAFT LOAN OR A LOAN FROM FRIENDS OR FAMILY) MAY BE MORE APPROPRIATE AND AFFORDABLE.  YOU MAY WANT TO DISCUSS YOUR FINANCIAL SITUATION WITH A NONPROFIT CREDIT COUNSELING SERVICE AVAILABLE TO CONSUMERS EXPERIENCING FINANCIAL PROBLEMS IN YOUR COMMUNITY.

 YOU WILL BE CHARGED ADDITIONAL FEES IF YOU RENEW THIS LOAN. As an example, suppose you borrow $200 for 14 days at an APR of 651.78%. The Finance Charge would be be $ 50.00. If you did not repay the loan at maturity but chose instead to refinance the balance by obtaining a new loan in the same amount for an additional 14-day period, you would incur an additional Finance Charge of $ 50.00. So, if you renew the $200 loan 4 times, the total Finance Charge you would be required to pay would be $250.00. Moreover, if there were insufficient funds in your bank account on the date we attempted to effect an ACH debit entry to pay all or part of what you owe, you would incur a Return Item Fee of $30. Your Bank may also impose fees for returning ACH debit entries unpaid and, if this practice persists, may even cancel your deposit account.

RIGHT TO CANCEL.  YOU MAY CANCEL THIS LOAN, WITHOUT COST OR FURTHER OBLIGATION TO US, IF YOU DO SO BY THE END OF BUSINESS ON THE BUSINESS DAY AFTER THE LOAN PROCEEDS ARE DEPOSITED TO YOUR CHECKING ACCOUNT.  To cancel, you must call us at (800) 582 - 7555 to alert us of your intention to cancel and you must complete the information in this box, sign and telefax this page to (800) 510 - 0799. If you follow these procedures but there are insufficient funds available in your deposit account to enable us to reverse the transfer of loan proceeds at the time we effect an ACH debit entry of your bank account, your cancellation will not be effective and you will be required to pay the loan and our charges on the scheduled maturity date.

SIGN HERE ONLY IF YOU WANT TO CANCEL THE LOAN. You authorize us to initiate an ACH debit entry to your bank account for the amount of the loan proceeds we deposited to that account at your request.

 

_____________________________                          X______________________                   ________________

Print Name                                                                                         Signature                                                               Date

REFINANCE POLICY:  So long as you continue to meet our credit granting standards on the due date of your loan and you pay the Finance Charge, we will permit you to refinance your loan up to 4 times without requiring you to make any reductions in principal, although you may always pay your loan in full or in part at any time.  Beginning with the 5th refinancing (whether or not principal reductions have previously been made) and for each later refinancing, we will require that you pay at least $50 in principal plus our Finance Charge until the loan is paid in full. 

COOLING OFF PERIODS:  If you pay your loan in full by cash or a cash equivalent (such as a money order), we require a 1-day cooling off period before you can obtain a "new" loan.  So, if you pay your loan in cash on a Monday, you cannot apply for a "new" loan until Wednesday.  (However, if you desire to obtain a new loan during the 1-day cooling off period, we will treat that new loan as a refinancing which will be governed by our Refinance Policy above.)  If you pay your loan in full by check or ACH debit, we require a 3-day cooling off period.  So, if you pay off your loan in full on a Monday, you cannot apply for a new loan until Friday.  However, if you so extend repayment of your loan that it is classified as on "watch status" and you are required to make at least $50 principal reductions with each extension, we require a 7-day cooling off period after you pay your loan in full.  So, if you pay off your loan in full on a Monday, you cannot apply for a new loan until the second following Tuesday.

LOAN LIMIT POLICY:  You may not apply for more than 15 new loans in any calendar year.  A loan begins when we advance the loan funds to you and ends when the loan is paid in full, regardless of the number of refinancings you may have obtained prior to making payment in full.

PRIVACY POLICY.  Protecting your privacy is important to County Bank and our employees.  We want you to understand what information we collect and how we use it.  In order to provide our customers with short term loans as effectively and conveniently as possible, we use technology to manage and maintain customer information.  The following policy serves as a standard for all County Bank employees for the collection, use, retention, and security of nonpublic personal information related to our short term loan programs. 

WHAT INFORMATION WE COLLECT.  We may collect “nonpublic personal information” about you from the following sources:

•Information we obtain from your applications or loan forms, such as your name, address, social security number, assets and  income;

•Information about your loan transactions with us, such as your payment history and loan balances; and

•Information we receive from third parties, such as consumer reporting agencies and other lenders, regarding your creditworthiness and credit history.

“Nonpublic personal information” is nonpublic information about you that we obtain in connection with providing a short term loan to you.  For example, as noted above, nonpublic personal information includes your name, social security number, payment history, and the like.

WHAT INFORMATION WE DISCLOSE.  We are permitted by law to disclose nonpublic personal information about you to third parties in certain circumstances.  For example, we may disclose nonpublic personal information about your short term loans to consumer reporting agencies and to government entities in response to subpoenas.  Moreover, we may disclose all of the nonpublic personal information about you that we collect, as described above, to financial service providers that perform services on our behalf, such as the servicer of your short term loan, and to financial institutions with which we have joint marketing arrangements.  Such disclosures are made as necessary to effect, administer and enforce the loan you request or authorize.

If you become an inactive customer, we will continue to adhere to the privacy policies and practices described in this notice. 

OUR SECURITY PROCEDURES.  We also take steps to safeguard customer information.  We restrict access to nonpublic personal information about you to those of our and our servicer's employees who need to know that information to provide short term loans to you.  Our physical, electronic and procedural safeguards that comply with federal standards guard your nonpublic personal information. 

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