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 Harrisburg Quick Cash, 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 Harrisburg

Quick Cash, Inc. to the extent not prohibited by law.  I/We understand that Harrisburg Quick Cash, 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 Harrisburg Quick Cash, Inc.
Harrisburg Quick Cash, Inc. 114 S. Commercial St. Harrisburg, IL 62946 Ph 618-253-6565

CONSUMER INSTALLMENT LOAN APPLICATION (205 ILCS 670/1 et seq)
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HARRISBURG