Loan applicant(s) agrees and acknowledges that in the event any item issued by him/her is not honored by applicant's bank for any
reason including non-sufficient funds, closed account, stop payment, etc., there will be an automatic additional Return Item Fee of

$25.00 charged and due.

In the event customer fails to honor loan agreement regardless of Security obtained by Lender, the account may be turned over for
collection, repossession, and/or legal action may be initiated to recover the amount due as detailed in the Loan Agreement.

I/We agree CQC, Inc. and/or their representative may contact any person listed on this Installment Loan Application form or any other
persons having dealings with me in order to obtain information and/or discuss any debts which I owe CQC, Inc. to the extent not
prohibited by law.  I/We understand that CQC, Inc. may rely on other credit reporting agencies, including but not limited to Teletrack

Inc® and/or Veritec Services® to approve a Loan.  I/We waive any and all invasion of privacy claims against CQC, Inc.
CQC, Inc. dba Carbondale Quick Cash 820 E. Walnut St. Carbondale, IL 62901 Ph 618-351-6565

CONSUMER INSTALLMENT LOAN APPLICATION (205 ILCS 670/1 et seq)
Carbondale Quick Cash