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Form

Personal Information

Requested Amount
 
Social Security Number
Date of Birth
 
Date Of Birth
 
Dob Year
 
Gender
First Name
Middle Initial
Last Name
Address Line 1
Address Line 2
City
State
 
Zip
Home Phone Number
Cell Phone Number
Driver’s Licence State
 
Driver’s Licence Number
Best Time To Contact
Months And Years Lived In Current Address
 
Years Lived In Current Address
 
Rent Or Own
 
Are You In The Military
 
Are You A US Citizen
 
Subscribe To Future Offers
 
Email Address

Employment Information

Income Type
 
Payment Type
 
MONTHS AND YEARS You Worked For Current Employer
 
Years You Worked For Current Employer
 
Employer’s Name
Employer’s Address Line 1
Employer’s Address Line 2
Employer’s City
Employer’s State
Employer’s Zip Code
Employer’s Phone Number
Employer’s Extension Number
Employer’s Fax Number
Supervisor’s Name
Supervisor’s Phone Number
Supervisor’s Extension Number
Date You Were Hired
 
Date You Were Hired
 
Hire Year
 
Full Time Or Part Time
 
Job Title
Work Shift
Pay Frequency
 
Monthly Net Salary
Most Recent Payday
Next Pay Date
Second Pay Date

Banking Information

Account Holder Name
Bank Name
Bank Phone Number
Account Type
 
ABA Routing Number
Account Number
MONTHS AND YEARS Bank Acc Has Been Open
 
Number Of Years Bank Acc Open
 

Reference Information

First Name
Last Name
Phone Number
Relationship With Reference
 


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TERMS & CONDITIONS

Lone Star Cash is a subsidiary of  Kashia Services, a wholly owned business entity, of the Kashia Band of Pomo Indians of the Stewarts Point Rancheria, a federally recognized Indian tribe. 

 
Please note: This is an expensive form of borrowing and is not intended to be a long-term financial solution.
 

 

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