CASH CALL REGISTRATION FORM
ALL ENTRIES MUST BE RECEIVED BY THE DEPARTMENT BY MARCH 31ST, 2018 TO BE ELEGIBLE FOR CONSIDERATION.
Please follow the instructions below and mail or fax this completed form to:
ATTN: Cash Call Registration
3613 NW 56th St., Suite 240
Oklahoma City, Ok 73122
FAX: 405-521-3653
Instructions:
1. Fill out the information below COMPLETELY. Incomplete forms CANNOT be accepted.
2. If you have more than one loan number, please make copies of this form and fill one out for each loan number you have.
3. Please note that if you change your information between now and March 31st, 2018, you will need to resubmit your registration form(s).
4. If one or more of your letters does not have a loan number on it, it was not one of the loans eligible for a partial refund.
5. Your zip code must contain all 9 digits. To find your 9 digit number, please contact your local post office.
FIRST NAME: ___________________________ LAST NAME: _______________________________________
ADDRESS: _______________________________________________________________________________
CITY: ___________________________________________STATE: _____________ ZIP: ________-______
PHONE: _____________________ LOAN NUMBER: _________________________
SIGNATURE*: ______________________________________DATE SIGNED: _______________________
*by signing this form I testify that I am the person listed above.