Server: Netscape-Commerce/1.12 Date: Thursday, 18-Dec-97 08:28:34 GMT Last-modified: Saturday, 22-Nov-97 01:56:13 GMT Content-length: 9336 Content-type: text/html ACE Cash Express, Inc. General Information


To review ACE's Uniform Offering Circular (UFOC), complete the following application.

 Personal 
Name:
Social Security Number:
Address:
City:
State:
Zip Code:
Daytime Phone:
Evening Phone:
E-mail:
 
 
 Business 
Present Employer:
Position:
How Long:
 
 
 Financial Assets 
Cash in Banks:
Real Estate Owned Value:
Autos Owned Value:
Stocks and Bonds:
Other:
Total Assets:
 
 
 Liabilities 
Mortgage Owed:
Bank Loans:
Credit Cards:
Other:
Total Liabilities:
 
 
  
 Combined household income:a) Under $50,000
b) $50,000 - $75,000
c) $75,000 - $100,000
d) $100,000 - above
 Have you ever filed for bankruptcy? yes no
 How many stores would you like to be considered for?
 Location City of Choice
 Would you prefer: full service or kiosk
How would you finance your first store?
If approved, how soon would you want to start?


All the above information is correct and ACE has my permission to verify.

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