Loan Application and Credit Authorization

Step 1: Loan Application

Please fill out the form completely. Your information is encrypted (AES-256).

Name

This field is for validation purposes and should be left unchanged.

Select Your Location(Required)

S. Maryland Parkway

Desert Inn

Maryland Parkway Location, 3319 South Maryland Pkwy #1, Las Vegas, NV 89169 | Desert Inn Location, 4860 West Desert Inn Rd #3, Las Vegas, NV 89102

Requested Loan Amount(Required)

Enter the loan amount up to 2000

Date of Application(Required)

Applicant Information

Your Name(Required)

First Middle Last

Date of Birth(Required)

Social Security Number(Required)

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number:(Required)

Email Address(Required)

Employment Information

Employer Name(Required)

Work Phone Number(Required)

Monthly Expenses

Rent/Mortgage(Required)

Loans (Personal/Student/Other)(Required)

Car Payment(Required)

Car Insurance(Required)

Child Support

Other Monthly Expenses

Total Monthly Expenses

Applicant Disclosure & Certification

I certify that the information provided in this application is true and complete to the best of my knowledge. I authorize Koster’s Cash Loans to verify employment, income, and credit information for loan evaluation.

Applicant Signature(Required)

Applicant Name(Required)

Date