PayDayLoans4U

15 Day Extension

For customers with an outstanding "Payday Advance"

Extension must be submitted 3 days before due date.
Extension fees cannot be rolled over.
Extension fee is due on original "cash check date."

$25 for $100 loan
$50 for $200 loan
$75 for $300 loan
$100 for $400 loan
$125 for $500 loan

You must have the fee amount available in your account on the original date that your check was going to be cashed, before you request an extension.

All Fields in the form MUST be filled out completely

Account Information

Social Security Number: (xxx-xx-xxxx)
Last Name:	E-mail:

Banking Information

Name of Bank:		Bank Phone #:
Checking Account Number:

Fill out the check below to request your extension.

Due Date from Account due notice: (mm-dd-yyyy)	Amount:
Pay To:
Bank Name:	Please type your signature:
Type your routing number, bank account number, and check number in the boxs below (The line of digits on bottom of your check) Routing # Account # Check #

You have completed the extension request! You may be denied for an incomplete or inaccurate extension, so be sure all of the information is correct. We will notify you by e-mail as to if you were approved, and when your due-date will be.

Terms and Conditions
Before clicking submit on this on-line extension, please read the following terms and conditions carefully. By submitting this extension request, and by accepting any loans from , you agree to the terms entirely:

1) You authorize to withdraw on your extension amount noted above. You understand that your full loan amount and fee will be extended for 15 days from your original due date. You understand that these and all transactions will be done electronically using our ACH system.

2) In the event of a default on your account, you will be responsible for all costs that may be associated with the attempt by .com to collect any outstanding balance of this loan and fees, including but not limited to any fees or charges associated with bank NSF or returned checks, court costs, attorney fees, costs of being served, pre and post judgment interest, etc.

3) Upon the occurrence of one or more of the following events of default; (1) failure to make any monthly payments when due; (2) failure to perform any obligation under any security agreement securing this note; (3) borrower defaults under any other credit extension with Lender; (4) borrower should die, or become insolvent, or apply for bankruptcy or other relief from creditors; (5) lender reasonably believes itself to be insecure in the repayment of this note. Lender may, at its option, declare the entire unpaid balance of this note to be due immediately and payable without notice or demand.

4) By submitting this form and faxing the additional information you are in a binding agreement with .

Initial in this box to indicate that you have read and agree to all terms above.