Dispute Resolution Child Support

Application Disclosures

· You certify that the information you provide to us

is true and correct. Any false statement

made shall be sufficient basis for rejection, and you authorize verification of the truthfulness of all information you provide, including verification of income and banking information.

· You expressly authorize contact with any person or company identified to verify your information or to leave a message for you.

· You acknowledge that this application and any supporting documentation provided with it is the property of

· You authorize to perform credit

checks, searches and/or analysis of data in certain state-required databases, as well as other commercially available and/or proprietary databases, in order to identify consumers who have a record of transactions with certain lending institutions to verify truthfulness or accuracy of your information, and/or to determine whether or not you qualify for an advance.

· You understand that income from alimony, child support or separate maintenance payments need not be revealed if you do not wish to have it considered as part of your application.

· To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

· ARBITRATION (DISPUTE RESOLUTION): You agree that any and all disputes arising out of this application, or Advance America's evaluation of this application, shall be resolved solely by final and binding individual arbitration. You hereby waive your right to a trial by jury and your right to pursue the resolution of any dispute in a class action or to be a named or unnamed class member in any such action. You understand that this Dispute Resolution Provision will remain in effect if you withdraw or abandon your application.

You understand that you may choose to opt out of this Dispute Resolution Provision by following the procedures set forth below. If you do not wish to be bound by this Dispute Resolution Provision, and you do not sign a Customer Agreement with Advance America, you understand that you must notify Advance America of your decision to opt out within thirty (30) days after the date of this application. Opt-out notices must be sent to:,

Attn: Arbitration Opt-out, P.O. Box 3058, Spartanburg, SC 29304-3058. You understand that the notice must include your name, address, social security number, the date of the application and a statement that you wish to opt out.

Applicant's Signature: Date:

Lindsey Stroupes

(Advance America)

07/27/2022

Advance America, Cash Advance Centers of Tennessee, Inc. Advance America, Cash Advance Centers of Tennessee, Inc. Advance America.

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