Yes, I am at least 18 years of age and everything that I have stated here is correct to the best of my knowledge. I understand that you will retain this information whether or not I am later approved for a loan. To view the Privacy Policy, click
here
I acknowledge that as of the date of this application, I have received the pamphlet entitled "Short-Term Lending in the Commonwealth of Virginia—Borrower Rights and Responsibilities"
Initials
1. Are you a regular or reserve member of the United States Army, Navy, Marine Corps, Air Force, Coast Guard, or National Guard serving on active duty under a call or order that does not specify a period of 30 days or fewer?
Yes
No
2. Are you married to a regular or reserve member of the United States Army, Navy, Marine Corps, Air Force, Coast Guard, or National Guard serving on active duty under a call or order that does not specify a period of 30 days or fewer?
Yes
No
3. Are you under the age of 18 and the son or daughter of a regular or reserve member of the United States Army, Navy, Marine Corps, Air Force, Coast Guard, or National Guard serving on active duty under a call or order that does not specify a period of 30 days or fewer?
Yes
No
4. Was more than one-half of your financial support for the past 180 days provided by a regular or reserve member of the United States Army, Navy, Marine Corps, Air Force, Coast Guard, or National Guard serving on active duty under a call or order that does not specify a period of 30 days or fewer?
Yes
No