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Apply Online for an Installment Loan

Loan applicant agrees and acknowledges that in the event any check and/or ACH 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 CQC, Inc. (Lender).   CQC, Inc.
may exercise its option to accelerate upon any default by Borrower regardless of prior forbearance.

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

I agree CQC, Inc. and/or their representative may contact any person listed on this Installment Payday 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 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 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

INSTALLMENT PAYDAY LOAN APPLICATION
I Agree
I Do Not Agree