Cash Advance Agent. Please fill out the following form to register as an Agent to represent the Simple Cash Funding Program. Although you are already an agent of Simple Cash Funding or one of its affiliated companies, you will need to register for a new Agent ID to represent the Simple Cash Funding Program. You will receive an email with details of the program and useful links and tips on promoting the program.

Note: Fields marked with (*) are required fields. *Company Name: *Contact Name: *Address 1: Address 2: *City: *State: Choose State Other AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY *Zip Code: *Phone Number 1:  Ext: Phone Number 2:  Ext: Fax Number: Best time to contact you: *Email Address: