I understand that Franklin County Financial Services may assign my contract, entered into by me, as a result of my making this application. 

DISCLOSURE REGARDING ACCOUNT INFORMATION:
From time to time Franklin County Financial Services may share information about me with its affiliates. I may prohibit your doing so,
except for information pertaining solely to transactions or experiences between Franklin County Financial Services and me by providing written
notice to Franklin County Financial Services. Such notice will include my account/loan number, name of account holder, address, and
telephone number; and will be sent to FCFS Compliance Department.
Further, if I believe that any information relating to me held by Franklin County Financial Services is inaccurate, I will notify Franklin County Financial Services of the specific information that is inaccurate.

CONSENT AND AUTHORIZATION:
The information that I have stated in this Application is complete and correct, and no material debts have been
omitted. I acknowledge that Franklin County Financial Services is relying upon the complete accuracy of the information submitted, and that
false or misleading information constitutes an attempt to defraud Franklin County Financial Services. I hereby authorize Franklin County Financial Services to obtain, verify and confirm any information about me, or my credit and employment history, from credit reporting agencies,
directly from my Franklin County Financial Servicess, my landlord or other businesses or individuals, and my current or former employers. I
consent to such persons or entities providing such information to Franklin County Financial Services; and, I consent to Franklin County Financial Services furnishing the information that I have provided and my payment history, to those with whom Franklin County Financial Services believes that I have a credit account or am opening an account.

*By clicking submit you are agreeing to the terms and conditions stated in the above disclosure and consent statement.