Loan Request Complete the information below, as you would on a new check: .................................................................................................................  Check #:  Date: (dd/mm/yy):  Pay To: 300Cash.com ...............Amount:  260 Dollars.  ****Two Hundred Sixty and 00/100** Dollars  Bank Account Number:  Bank Name:      Please type your Signature  .................................................................... I authorize 300Cash.com, Inc to immediately deposit $200 into my checking or savings account and to withdraw from the same checking or savings account $200 plus the $60 fee on the date specified above. I understand that there is a $19.00, one-time only non-refundable application fee, payable on the submission of this application and I also understand that I will be charged a $25 fee any time an electronic transaction is returned unpaid by my bank including Non-Sufficient Funds. It is also agreed and acknowledged that this transaction and all future transaction between me and 300cash.com, Inc. are transacted according to the Master Agreement, Arbitration Agreement and all other agreements which are displayed on the website. I have read the disclosure agreement which are displayed on the website and acknowledge constructive receipt of said agreements. I AGREE Yes No