Loan Disclosure
I hereby authorize A-1 Cash Advance and its affiliates to use my personal and confidential information in any manner consistent with the A-1 Cash Advance privacy policy which can be viewed by clicking the applicable link at the bottom of this web page.
I certify that the information supplied by me is true and correct. I authorize verification of the truthfulness of all information contained herein, including verification of income and banking information. I expressly authorize contact with any person or company identified above to verify any of the above information or to leave a message for me. Any false statement made by me shall be sufficient basis for rejection. I have read and understand the above statements. I acknowledge that this application and any supporting documentation provided with it is the property of A-1 Cash Advance. I represent that I am neither a current nor a former A-1 Cash Advance employee nor am I a spouse or relative of a current or former employee.

I attest that 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 less. Nor am I an Active Guard and/or Reserve member of the military currently serving on active duty or who has served on active duty within the past 180 days. Nor am I a spouse, child, or other dependant person who derives more than on-half of my monetary support from a member of the military who is on active duty or has been on active duty within the past 180 days.

Terms of Agreement
TRUTH OF APPLICATION: You certify that the information stated on this loan is true and correct. You also warrant and represent that you are not a debtor under any proceeding in bankruptcy, insolvency or reorganization and have no intention to file a petition for relief under any chapter of the United States bankruptcy code as presently published and existing. You understand that we are relying upon the application and this loan agreement. You authorize us to verify any information through any source including use of credit report.

METHOD OF PAYMENT: Your personal check, or authorization to debit your account, in the amount of the Total of Payments stated in Our disclosures and dated as of the date indicated in the Payment schedule stated in Our Disclosures the”Payment Due Date”) will be held by us until the Payment Due Date as security for this loan. You agree that we may deposit this check, or or initiate an ACH debit to your bank account to satisfy this obligation, if you have not paid us in cash or by cashier’s check, money order or other immediately available funds in the amount of the Total of Payments on or before the Payment due Date. If payment is made prior to the deposit of your personal check, or ACH debit to your bank account, we will return the check to you at the time we receive payment.

WAIVERS: We shall not waive any of our rights under this loan agreement by making an accommodation for you or someone else. No waiver, consent or approval by us or change or amendment of this loan agreement effective unless it is in writing, and we have signed it.

JOINT AND SEVERABLE: If this loan agreement is signed by more than one Borrower, you each agree to be liable to us Jointly, and each of you will be liable to us individually for the loan and other obligations under this loan agreement. We may require that any one of you pay the whole loan without making anyone else to pay. We may sue any one of or more of you without giving up any of our rights against the others. This loan agreement is also binding upon the heirs and personal representatives in probate of all signers and upon anyone to whom signer assigns his assets or who succeeds to him or her in any other way.

TIME: It is essential that you make your payments and keep all your promises under this loan agreement on time.

PREPAYMENT: If you prepay to us the Amount Financed, no later than the end of the business day immediately following the day on which this Loan Agreement was made, we will refund to you the Finance Charge we have earned. If you payoff this loan at any time after the end of the business day immediately following the day on which this Loan Agreement was made, you will not be entitled to a refund of part of the Finance Charge.

CONSECUTIVE SMALL LOANS: After your initial loan an three (3) consecutive small loans, we are required to offer you an extended payment plan (EPP) at the time you enter into the fourth small loan agreement if you are not in default on you existing loan. The EPP can be entered into at any time after the fourth loan. If you enter into an EPP, you will not be able to enter into another small loan with any small loan lender until the EPP is paid in full and the seven day waiting period has expired. A seven day cooling-off period applies after you have had a total of six loans (an initial loan followed by five consecutive loans) with any one lender

DEFAULT: You will be in default under this agreement if: (a) you stop payment of the Check or otherwise fail to pay the Total of Payments on or before the Payment Due Date stated on this loan agreement, or (b) you provide false or misleading information about yourself, your employment or your financial condition (including the account on which the Check is drawn) prior to entering this loan agreement.

THINGS WE HAVE THE RIGHT TO DO TO PROTECT OURSELVES IF YOU DEFAULT: Whenever you are in default under this loan agreement we can go to court and get a judgment against you for the then unpaid amount of your debt.

RETURNED CHECK CHARGES: An additional charge of twenty-five ($25) will be charged for the return by a bank or other depository institution of a dishonest check, negotiable order of withdrawal, electronic withdrawal, or share draft issued by the consumer. This additional charge will be assessed one (1) time regardless of how many times a check may be submitted by the Lender and dishonored.

CREDIT INQUIRE AUTHORIZATION: You agree and hereby authorize us to obtain credit reports on you both now and at any time any portion of the Amount Financed remains owed to us.

CREDIT REPORTING: We may report your performance under this loan agreement to credit reporting agencies. You agree and hereby authorize us to obtain credit reports on you both now and at any time any portion of the Amount Financed remains owed to us. You specifically acknowledge and agree that we may disclose any default by you under this loan agreement, along with other relevant information, to credit reporting agencies.

ARBITRATION PROVISION: WAIVER OF JURY TRIAL AND ARBITRATION PROVISION. Arbitration is a process in which persons with a dispute: (a) waive their rights to file a lawsuit and proceed in court and to have a jury trial top resolve their disputes; and (b) agree, 0instead, to submit their disputes to a neutral third person (an “arbitrator”) for a decision. Each party to the dispute has an opportunity to present some evidence to the arbitrator. Pre-arbitrate discovery may be limited. Arbitration proceeding are private and less formal than court trials. The arbitrator will issue a final and binding decision resolving the dispute, which may be enforced as a court judgment. A court rarely overturns an arbitrator’s decision.


1. For purposes of this Waiver of Jury Trial and Arbitration Provision (hereafter the”Arbitration Provision”), the words “dispute and “disputes” are given the broadest possible meaning and include, without limitation

a. all claims, disputes, or controversies, arising from or relating directly or indirectly to the signing of this Arbitration Provision, the validity and scope of the
Arbitration Provision and any claim or attempt to set aside this Arbitration Provision;

b. all federal or state claims, disputed or controversies, arising from or relating directly or indirectly to this Loan Agreement (including the Arbitration Provision), the information you gave us before entering into this Loan Agreement, including the customer Information Sheet, and/or any past agreement or agreements between you and us;

c. all counterclaims, cross-claims and third-party claims;

d. all common law claims, based upon contract, tort, fraud, or other intentional torts;

e. all claims based upon a violation of any state or federal constitution, statute or regulation;

f. all claims asserted by us against you, including claims fir money damages to collect any sum we claim you owe us;

g. all claims asserted by you individually against us and/or any of our employees, agents, directors, officers, shareholders, governors, managers, members, parent company or affiliated entities (hereinafter collectively referred to as “related third parties”), including claims for money damages and/or equitable or injunctive relief;

h. all claims asserted on your behalf by another person;

i. all claims asserted by you as a private attorney general, as a representative and member of a class of persons, or in any other representative capacity, against us and/or related third parties (hereinafter referred to as”Representative Claims”); and/or (j) all claims arising from or relating directly or indirectly to the disclosure by us or related third parties of any non-public personal information about you.

2. You acknowledge and agree that by entering into this Arbitration Provision:




3. Except as provided in Paragraph 6 below, all disputes including any Representative Claims against us and/or related third parties shall be resolved by binding arbitration only on an individual basis with you. THEREFORE, THE ARBITRATOR SHALL NOT CONDUCT CLASS ARBITRATION; THAT IS, THE ARBITRATOR SHALL NOT ALLOW YOU TO SERVE AS A REPRESENTATIVE, AS A PRIVATE ATTORNEY GENERAL, OR IN ANY OTHER REPRESENTATIVE CAPACITY FOR OTHERS IN THE ARBITRATION.

4. Any party to a dispute, including related third parties, may send the other party written notice by certified mail return receipt requested of their intent to arbitrate and setting forth the subject of the dispute along with the relief requested, even if a lawsuit has been filed. Regardless of who demands the arbitration, you shall have the right to select any of the following arbitration organizations to administer the arbitration according to the organization’s rules applicable to consumer disputes: the American Arbitration Association (1-800-778-7879), J.A.M.S./Endispute (1-800-626-5267), or National Arbitration Forum (1-800-474-2371) However, the partied may agree to select a local arbitrator who is an attorney, retired judge, or arbitrator registered and in good standing with an arbitration association and arbitrate pursuant to such arbitrator’s rules applicable to consumer disputes. the party receiving notice of arbitration will respond in writing by certified mail return receipt requested within twenty (20) days. If you demand arbitration, you must inform us in your demand of the arbitration organization you have selected or whether you desire to select a local arbitrator. If related third parties or we demand arbitration, you must notify us within twenty (20) days in writing by certified mail return receipt requested of your decision to select an arbitration organization or your your desire to select a local arbitrator. If you fail to notify us, then we have the right to select an arbitration organization. the parties to such dispute will be governed by the rules and procedures of such arbitration organization applicable to consumer disputes, to the extent those rules and procedures do not contradict the express terms of this Loan Agreement or the Arbitration Provision, including the limitations on the arbitrator below. You may obtain a copy of the rules and procedures by contacting the arbitration organization listed above.

5. Regardless of who demands arbitration, at your request we will advance your portion of the arbitration expenses, including the filing, administrative, hearing and arbitrator’s fees (“Arbitration Fees”). Throughout the arbitration, each party shall bear his or her own attorney’s fees and expenses, such as witness and expert witness fees. The arbitrator shall apply applicable substantive law consistent with the FAA, and applicable statutes of limitation, and shall honor claims of privilege recognized at law. The arbitration hearing will be conducted in the county of your residence, or within 30 miles from such county, or in the county in which the transaction under this Loan Agreement occurred, or in such other place as shall be ordered by the arbitrator. The arbitrator may decide, with or without a hearing, any motion that is substantially similar to a motion to dismiss for failure to state a claim or a motion for summary judgment. In conducting the arbitration proceeding, the arbitrator shall not apply any federal or state rules of civil procedure or evidence. If allowed by statute or applicable law, the arbitrator may award statutory damages and/or reasonable attorneys’ fees and expenses. If the arbitrator renders a decision or an award in your favor resolving the dispute, then you will not be responsible for reimbursing us for your portion of the Arbitration Fees, and we will reimburse you for any Arbitration Fees you have previously paid. If the arbitrator does not render a decision or an award in your favor resolving the dispute, then the arbitrator shall require you to reimburse us for the Arbitration Fees we have advanced, not to exceed the amount which would have been assessed as court costs if the dispute had been resolved by a state court with jurisdiction, less any Arbitration Fees you have previously paid. At the timely request of any party, the arbitrator shall provide a written explanation for the award.

6. All parties, including related third parties, shall retain the right to seek adjudication in a small claims tribunal for disputes within the scope of such tribunal’s jurisdiction. Any dispute, which cannot be adjudicated within the jurisdiction of a small claims tribunal, shall be resolved by binding arbitration. any appeal of a judgment from a small claims tribunal shall be resolved by binding arbitration.

7. This Arbitration Provision is made pursuant to a transaction involving interstate commerce and shall be governed by the FAA.

8. This Arbitration Provision is binding upon and benefits you, your respective heirs, successors and assigns. The Arbitration Provision is binding upon and benefits us, our successors and assigns, and related third parties. The Arbitration Provision continues in full force and effect, even if your obligations have been prepaid (including if the Loan Agreement has been rescinded by such prepayment); paid or discharged through bankruptcy. the Arbitration Provision survives any rescission, termination, amendment, expiration or performance of any transaction between you and us and continues in full force and effect unless you and we otherwise agree in writing. If any of this Arbitration Provision is held invalid, the remainder shall remain in effect.

PRIVACY STATEMENT: We will not disclose to others the information that you provide to us except as disclosed in this statement, sometimes it may be necessary to release your name and/or other information to government agencies in order to comply with the law. However, we will not release any information unless we are legally required to do so and will provide only the information that the agency requests. We may release your name and/or any other information that you provide to check your credit and verify the information supplied by you as part of this contract. We may release your name and/or any other information that you provide in order to collect any money due us, either under this or any other agreement that you may have with us. We do not currently offer our customer list to other companies. However, we reserve the right to change this policy at any time.

GOVERNING LAW: This loan agreement will be governed by and construed and enforced solely in accordance with the internal laws of the State of Indiana. YOU AGREE THAT THE STATE COURTS LOCATED IN THE STATE OF INDIANA WILL HAVE EXCLUSIVE JURISDICTION AND VENUE OF ACTIONS TO ENFORCE THIS LOAN AGREEMENT.

ASSIGNMENT: We may assign or transfer this loan agreement or any of our rights hereunder. Your obligations under this loan agreement cannot be assigned to a third party without our prior written consent.

Indiana Small Loan Law – Borrower Rights and Responsibilities
Please take the time to carefully review the information contained in this pamphlet. It is designed to advise you of your rights and responsibilities in connection with obtaining a small loan in Indiana pursuant to Indiana Code 24-4.5-7-104 et seq. If you have any questions about small loans or want additional information, you may contact the State of Indiana Department of Financial Institutions toll-free at (800) 382-4880 or on the Internet at

In General: You are responsible for evaluating whether a small loan is right for you. Alternatives may include,among other things, less expensive short-term financing from another financial institution, family, or friends, a cash advance on a credit card, an account with over-draft protection, or a loan repayable over several months.

Notice from Lender: The lender is required to provide you with a clear and conspicuous printed notice advising you that, among other things, a small loan is not intended to meet long-term financial needs and that you should use a small loan only to meet short-term cash needs.

Limitations on Security Interest: The lender cannot require you to provide more than one check or authorization to debit your account as security for any small loan. The check or authorization to debit may not exceed the amount advanced to or on behalf of the borrower plus loan finance charges contracted for and permitted. A small loan may not be secured by personal property of any type other than a check or electronic debit authorization.

$500 Maximum/Fourteen Day Minimum Term: A lender cannot have loans (either single or in the aggregate)outstanding to you at any one time in the principal amount/ amount financed of more than $500. A lender cannot make a small loan to a borrower who has two (2) or more small loans outstanding, regardless of the total value of the small loan. By law, the due date of your loan must be at least fourteen days after the date that money is advanced to you.

Loan Amount, Charges, etc.: The lender is prohibited from making a small loan to you that exceeds 15% of your monthly gross income. Finance charges on the first $250 of a small loan are limited to 15% of the principal (i.e. $30 on a $200 advance).

Finance charges on a small loan greater than $250 and less than or equal to $400 are limited to 13% of the amount over $250 and less than or equal to $400 (i.e. $44 on a $300 advance).

Finance charges on the amount of the small loan greater than $400 and not more than $500 are limited to 10% of the amount over $400 and not more than $500 (i.e. $62 on a $450 advance).

Other than the specific fees and costs discussed in the section of this pamphlet entitled “Failure to Repay” (see below), no additional amounts may be directly or indirectly charged, contracted for, collected, received, or recovered by the lender. You may receive your loan proceeds in the form of a check from the lender. The lender cannot charge you a fee for cashing their check. Similarly, a check casher affiliated with the lender cannot charge you a fee for cashing the lender’s check.

Written Agreement: The lender must provide you with a written loan agreement, which must be signed by both you and an authorized representative of the lender. The loan agreement is a binding, legal document which requires you to repay the loan. Make sure you read the entire loan agreement carefully before signing and dating it.The lender must provide you with a duplicate original of the loan agreement at the time of your loan transaction.

Right to Cancel: You have the right to cancel your small loan at any time prior to the close of business on the next day the lender is open following the date your small loan is made by paying the lender the amount advanced to you in cash, certified check, authorized account debit, cashier’s check, money order or, if the lender is equipped to handle such payments, by using a credit or debit card.

Partial Payments: You have the right to make partial payments in any amount on your small loan at any time before the due date without charge. You have the right to receive signed, dated receipts for each payment made showing the amount paid and the balance due on the small loan.

No Renewals: The lender cannot renew, repay, refinance, or consolidate your small loan with the proceeds of another small loan made to you by the lender. On the due date of your loan, you must either pay the lender in full by cash or allow the lender to deposit your personal check that they are holding or by debiting your account by written authorization.

Consecutive Small Loans: After an initial loan and five subsequent consecutive loans, the lender may not provide you with another small loan within seven (7) days after the due date of the fifth consecutive loans. You and the lender can agree to enter into a simple interest loan payable in more than four (4) installments. The Annual Percentage Rate (APR) on this loan cannot exceed 36% on loans with an amount financed up to $990 as per IC 24-4.5-3-508 effective July 1, 2004. The purpose of this provision is to help keep borrowers from being on a debt treadmill where they cannot payoff their loan.

Failure to Repay: Pay back your loan! Know when your payment is due and be sure to repay your loan on time and in full. You are responsible for having sufficient funds in your checking account on the due date of your loan so that your check does not bounce if the lender deposits it in his account.

If you cannot or do not repay the loan, then the lender is permitted to recover from you a charge, not to exceed $20, for each returned check, dishonored check, etc. This charge may only be assessed one (1) time regardless of how many times a check or authorization to debit your account is dishonored.

The lender is prohibited from threatening or beginning criminal proceedings against you if a check you provide to the lender bounces.

Debt Management and Credit Counseling Services: Debt management companies can provide assistance to consumers who need help reorganizing their debts. In addition, consumer credit counseling services can provide valuable financial education and budgeting advice. They can work with consumers and their creditors to coordinate repayment agreements and to help make their finances more manageable. To obtain a list of such companies, consult the business section of your phone book. The use of a credit counseling service will most likely result in charges to be paid by the consumer; therefore, when seeking help from a credit counselor, the consumer should ask for a full disclosure of the total cost, the benefits to be provided, and all other related information. Many organizations offer this service at charges much less than their competitors, so the consumer should always compare costs.

Complaints and Contacting the Department of Financial Institutions. For assistance with any complaints you may have against a small loan lender, please contact the Indiana Department of Financial Institutions toll-free at (800) 382-4880 or on the Internet at

A-1 Cash Advance
5511 East 82nd Street, Suite A
Indianapolis, IN 46250
Phone: 317-579-1600
Fax: 317-596-9083

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