Privacy Policy

REPUBLICASH respects your right to privacy.

This privacy policy sets out how REPUBLICASH uses and protects any information that you give REPUBLICASH when you use this website. REPUBLICASH is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this website, then you can be assured that it will only be used in accordance with this privacy statement. REPUBLICASH may change this policy from time to time by updating this page. You should check this page from time to time to ensure that you are happy with any changes. This policy is effective from 01-01-2016.


We may collect the following information:

– name and job title
– contact information including email address
– demographic information such as postcode, preferences and interests
– other information relevant to customer surveys and/or offers


We require this information to understand your needs and provide you with a better service, and in particular for the following reasons:

– Internal record keeping.
– We may use the information to improve our products and services.
– We may periodically send promotional emails about new products, special offers or other information which we think you may find interesting
using the email address which you have provided.
– From time to time, we may also use your information to contact you for market research purposes. We may contact you by email, phone, fax or
mail. We may use the information to customize the website according to your interests.


Our website may contain links to other websites of interest. However, once you have used these links to leave our site, you should note that we do not have any control over that other website. Therefore, we cannot be responsible for the protection and privacy of any information which you provide whilst visiting such sites and such sites are not governed by this privacy statement. You should exercise caution and look at the privacy statement applicable to the website in question.







Employer (or source of income)
Work Address: (Area Code) (yr / mos)
Work Phone
Take home $
Time at job?

Pay Period (Weekly/Monthly/Twice per Month)
Next Payday?

Job title
□ Full Time □ Part Time
Supervisor's Name
Supervisor's Phone #

Ever file bankruptcy? □ Yes □ No

Discharge Date
In bankruptcy now?

Previous Employer

Discharge Date

Hours per week? □ Yes □ No (If under 3 yrs at current)

Make of Car ___________________
Model ________________
Year _______
Color _______________
License plate # ______________
State ______




Consent For Credit Information

By signing "Consent for Credit Information", I/We understand that I/We give RepubliCash the right to use this document for the purpose of obtaining any and all info which may be pertinent to securing a pay day advance loan, (hereinafter "loan") I/we understand that information may be requested from the following sources: past, present employers, financial institutions, or any source which relates to credit matters, debt obligations, and available assets which could affect my/our loan. The interest obtained by the lender, its agents or assigns is to be used in the processing of my application for a loan. This information may also be used in conjunction with quality control review of the file after the loan has closed.

This form may be reproduced or photocopied and when used shall be as effective as the original signed document currently held by the lender.


Equal Credit Opportunity Notice

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants in the basis of race, color, religion, national origin, sex, status or age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income has been derived from any public assistance program; or because the applicant has , in good faith, exercised any right under the consumer credit protection act. The federal Agency that administers compliance with the law concerning this creditor is:

The Federal Trade Commission Washington, DC 20508


Consumer Protection Bond

A consumer protection bond is on the file with the State of Maine. If you have a claim against our company which cannot be resolved through informal means, you may take action to recover your loss from that bond by filling a written complaint with the Director, Office of Consumer Credit Regulation, 35 State House Station, Augusta, ME 04333-0035



I understand that RepubliCash does not perform a lengthy credit check on applicants but does perform a search in the Tele-Track database. Tele-Track is a national database of consumers who have a record of certain transactions in certain industries including, but not limited to, deferred deposit, check cashing, rent-to-own, cable television, accounts, consumer finance companies, and retail furniture stores. I agree to and authorize such a search.

Please Read Before Signing

I certify that the information supplied by me is true and correct. I authorize verification of the truthfulness of all information contained herein, including contact with a firm listed above, and fully release all parties from any and all liability for any damage that may result. Any false statement made by me shall be sufficient basis for RepubliCash. I acknowledge that this application and any supporting documentation provided with it is the property of RepubliCash LLC.