Form Completion: 0% done! Form Completion: 0% done! Need assistance? Get in touch! 1-888-226-1026 Claim your cash now! Applying takes less than 5 minutes No credit check To be eligible for a loan, you must meet the following criteria: Be at least 18 years old Have a Canadian bank account (active for at least 3 months) in which you are paid by direct deposit from your employer Have a stable job (for at least 3 months) and a monthly income of at least $1200, received by direct deposit from your employer Have few or no non-sufficient fund transactions Not be considering bankruptcy or entering into a consumer proposal Be a Canadian citizen residing in Ontario, PEI, British-Columbia or Alberta Have a low short-term debt ratio (minimal other active short-term or payday loans) The funds will be deposited into your bank account the same day of approval if your application is approved before 2:30pm. Your Personal Info First Name* Last Name* Email* Date of Birth* Year 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Home Phone Number* Cell Phone Number* Sex* Male Female Social Insurance Number Your Residential Info Address* Apt. City* Province* Choose... Alberta British Columbia Newfoundland and Labrador Manitoba New Brunswick Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Nunavut North West Territories Yukon Postal Code* Your Revenue Info Source of Income* Choose... Employed Employment Insurance Retirement, CPP Other Other Income* Choose... Disability (CMSM, WCB, ISB, AISH, ODSP) Insurance Income Student Loan Child Tax Social Assistance Self-Employed Name of the Employer* Work Phone Number* Ext. Your Job Description* Name of Immediate Supervisor* Approximate Hiring Date* Year 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 When did you start getting EI?* Year 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Are you paid by?* Direct Deposit Cheques Pay Frequency* Choose... Every week Every 2 weeks Every 4 weeks Every month, on a specific date Every month, on a specific week Every month, on the last day Twice a month, on specific dates Twice a month, on specific weeks Next Pay Deposit?* Information required to claim your cash Amount* How would you like to receive your funds?Direct Deposit(Free) – Funds are deposited directly into your account the same day of approval so long your application is approved by 2:30PM EST.Instant Deposit(+$5.00) – Your funds will be deposited directly into your account within 1 - 2 hours of approval. Direct Deposit Instant Deposit Are you planning on declaring bankruptcy or entering a consumer proposal?* Yes No Have you ever declared bankruptcy in the past?* Yes No Your Bank* Please choose TD Canada Trust CIBC Royal Bank (RBC) Bank of Montreal Bank of Nova Scotia Other Institution Number* Please choose 006 (National Bank) 016 (HSBC) 030 (Canadian Western Bank) 219 (Alberta TBF) 614 (ING Direct) 806 (Duca Financial Services) 809 (Credit Union BC) 810 (All Trans Financial Services) 815 (Caisse Populaire Desjardins) 819 (Desjardins) 828 (Credit Union Ontario) 829 (Desjardins Ontario) 830 (Airline FInancial Credit Union) 834 (Community First Credit Union) 837 (Meredian CU) 839 (Credit Union He - NS) 842 (Alterna Savings And Credit Union) 846 (Ontario Civil Services) 849 (Brunswick Cr Union Fredericton) 865 (Caisse Populaire Acadie) 879 (Credit Union MA) 889 (Credit Union Central Saskatchewan) 890 (Alliance Caisses Pop De L ontario) 899 (Credit Union AB) Other I don't know Your 5-Figure Transit Number* Your Account Number* Your Safety Contact Sharing a safety contact with us is your way of showing us that you intend to use our services with good intentions. What is a Safety Contact? First Name* Last Name* Telephone Number* Your Relationship with Your Contact* Please choose Spouse Father Mother Child Sister Brother Friend Other By submitting this form, I confirm that the info I provided is exact and current, and that I have read and accepted the terms and conditions. I accept periodical contact by Captain Cash by email with promotions or updates regarding my account.