| Select your residence state: |
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| Your First Name |
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Last Name |
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| Email |
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Best # to be reached at now |
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| Work or alternate phone: |
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Your ZIP code: |
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| Your Address |
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City |
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| Do you Own or Rent your home? |
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Are you working and living in the US? |
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| Are you, or are you the dependent of someone employed by a branch of the U.S. Military? |
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What is the best time to be reached? |
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| Your MONTHLY income: |
$
.00 |
Do you have a bank account? |
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| Do you have Direct Deposit? |
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How often are you being paid? |
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| When are your next 2 pay dates? |
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Up to what loan amount
would you like to receive? |
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How long have you lived
at your current residence? |
Years
Months |
What is your main source of income? |
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| Your occupation: |
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Employer |
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| Supervisor name |
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Supervisor phone |
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| Work or alternate phone: |
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How long have you been employed
with your current employer? |
Years
Months |
| Should you accept your loan, into what bank account would you like to receive it? |
| Your Bank Name: |
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Your Bank Account Number: |
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Bank phone |
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| Your driving license state |
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Driving license number: |
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| Your mother's maiden name: |
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Your birthdate (mm/dd/yyyy): |
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| Social Security number: |
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| Please give a personal reference |
| Full name: |
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Relationship |
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| Phone: |
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| Please give a SECOND personal reference |
| Full name: |
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Relationship |
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| Phone: |
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| Are you overwhelmed with debt and unable to pay your bills? Learn how |
| BANKRUPTCY CAN HELP keep what you have and reduce or eliminate your debt! |
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| Approximate your total unsecured debt (credit card or medical bills debt, unsecured loans, etc.) |
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| Optional Bonus Credit Line- Up To $12,5001! - |
| Nothing else to fill out! We already have your information, just click "Yes, Sign Me Up!" |
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Your AUTHORIZATION Required:
By choosing “Yes” I understand and authorize StarterCreditDirect to electronically debit my checking account for my one-time $99.00 Application and Processing fee. |
I also understand that USA Credit™, NOT StarterCreditDirect will electronically debit my bank account for the StarterCredit membership fee of $14 per month. My Starter Credit membership is being fulfilled by USA Credit as a service to StarterCreditDirect. By choosing “Yes”, I have read and agree to the Starter Credit Terms & Conditions¹ and the USA Credit™ Privacy Policy. I will allow 15-20 working days from the date my payment is verified and received, to receive my membership kit. I understand that Starter Credit is an authorized marketer of USA Credit™ membership programs. This account is a line of credit that can be used by an Accountholder to shop exclusively at the USA Credit™ Shopping Club Web Site. This is not a credit repair service. USA Credit™ is not a credit services organization, financial or banking institution. Do not use this charge account before you read the USA Credit™ Terms & Conditions for additional details. The USA Credit™ StarterCredit Shopping Card is not a VISA® or a MASTERCARD®. Guaranteed
qualifications: You must be 18 years of age, a U.S. Citizen
(EXCLUDING RESIDENTS OF WISCONSIN, VERMONT AND INDIANA)
OR PERMANENT RESIDENT. The $2,500 loan feature requires
prior on time repayment of product purchased at the USA Credit™ shopping club web site
Congratulations! |
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| You are also PRE-APPROVED for a new car loan. (bad or no credit OK with credit check) |
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| Your Monthly Payment for Rent or Mortgage |
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| Have you filed for bankruptcy in the past 7 years? |
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| Would you like a $10,000 Immediate Credit Line to use exclusively in our online mega store? |
| National Platinum Club™ gives you the purchasing power to buy the items you always wanted but never could afford! You have provided your basic information already! Simply choose YES to apply |
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By selecting the “YES” option above, I represent that I am at least 18 years of age, and have a valid US checking account. I also represent that I have read and agree to the Terms & Conditions and Privacy Policy associated with this offer. I also manifest my agreement to receive email and telemarketing from National Platinum Club™ and its marketing partners, and understand that my checking account will be debited the one time enrollment fee of $99.95, and $14.00 per month until cancelled for this membership. Questions? Please contact us at contact@memberservicesusa.com.
Gift card available only to members in good standing for 8 months from time of enrollment. This is not a debit or credit card. National Platinum´s Club™ allows the account holder to make merchandise purchases exclusively from its online shopping site. Most purchases from the online shopping site will require a down payment (up to 60%). Limit one gift card per household. Gift cards are redeemable at participating stores. We are not affiliated, sponsored, or endorsed by Visa U.S.A. Inc. or any other above listed companies. The Visa logo is a trademark owned by Visa U.S.A. Inc. All Terms and Conditions set forth on the gift card will apply. Click here to view the Visa Gift Card Terms & Conditions. Offer ends 12/31/2010. This offer not available to residents of Wisconsin |
| As a Homeowner,You may also qualify to Lower your Mortgage Payments and Stop Foreclosure with a New Government Program! |
| Are you behind on your mortgage? |
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Your credit |
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| Approximate your home value |
$
,000.00 |
Approximate your mortgage balance |
$
,000.00 |
| Second Mortgage |
$
,000.00 |
Your current interest rate
(round up to closest value) |
%
.00 |
Do you have a fixed
or an adjustable interest rate? |
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Is your First Mortage
Interest Only? |
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Have you started
Bankruptcy Proceedings? |
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Months behind on payments: |
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