Section 210.240  Consumer Written Verification of Compliance with Act

a)         Prior to the implementation of a certified database and in the absence of the availability of a certified database, a consumer written verification form must be completed to verify that a proposed loan agreement is permissible under the Act.

b)         The form must be in a separate document printed in 14-point bold type and must contain the following language:

1)         I currently have ____ outstanding loan(s) made pursuant to the Payday Loan Reform Act (the "Act") with a total principal balance of $______.

2)         I currently have ____ outstanding loan(s) under a Repayment Plan pursuant to Section 2-40 of the Act with a total principal balance of $______.

3)         I have not been indebted for a period of 45 consecutive days or more to any one or more lenders on a loan(s) made pursuant to the Act.

4)         Other than a loan in repayment pursuant to Section 2-40 of the Act, at least 7 calendar days have passed since the day that all loans made to me under the Act in any previous 45 day period were paid in full.

5)         At least 14 calendar days have passed since the day that the outstanding balance of a loan in a repayment plan pursuant to Section 2-40 of the Act and the outstanding balance of all other loans made pursuant to the Act were paid in full.

c)         The consumer must complete and sign the form attesting that the consumer understands that the lender making the loan under the Act is relying on the verification to determine whether the loan for which the consumer applied is permissible under the Act.