Online Application

Please fill out our online application below. Please note this is only an application for a loan and you will be required to bring in the supporting documentation listed below to receive final approval for your loan.

I live in the Memphis, New Orleans, Shreveport or surrounding area and will provide a recent paycheck stub, recent bank statement, telephone or utility bill, and driver's licence to the closest EZ Cash location to finalize the approval of your loan. NOTE: We do not process loans online.

 Yes No

Your Name

Your Email

Driver's Lic #

Your Telephone Number

Social Security


Your Address

Marital Status

 Married Single

Employment Information

Name of Employer

Employer Telephone

Length of Employment

How much do you get paid?

How often do you get paid?

Provide 4 References

Reference 1

First and Last Name

Phone #

Reference 2

First and Last Name

Phone #

Reference 3

First and Last Name


Reference 4

First and Last Name

Phone #

Have you had a loan with EZ Cash in the past?

 Yes No

Do you have any other payday loans out? If yes, list how may and how much.

 Yes No

Are you currently under bankruptcy?

 Yes No

Please Read Carefully

I certify that the information supplied is true and correct. By pressing submit below I authorize verification of the truthfulness of all information contained herein, including contact with any person or firm listed above, and I 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 rejection. I understand that EZ Cash does not perform a lengthy credit check on applicants but does perform a search in the Teletrack database. Teletrack is a national database of consumers who have a record of transactions in certain industries including, but not limited to, deferred deposit, check cashing, rent to own, consumer finance and retail furniture stores. I agree to and authorize such a search. I have and understood the above statements. I acknowledge that this application and supporting documentation provided with it is the property of EZ Cash.



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