Apply 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.  In the event there is no Check
and/or ACH associated with my loan, and my payments are not made in a timely manner as shown on the Loan
Agreement, I understand that Swansea Quick Cash, Inc. may require Borrower to immediately repay the entire
unpaid Total of Payments less any required refunds. Swansea Quick Cash, 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 action may be initiated to recover the amount due as detailed in
the Loan Agreement.

I agree Swansea 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 Swansea Quick Cash, Inc. to the extent not prohibited by law.  I understand that
Swansea 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 waive any and all invasion of privacy claims against
Swansea Quick Cash, Inc.
Swansea Quick Cash, Inc. 2708 N. Illinois, Swansea, IL 62226 Ph 618-235-3636

CONSUMER INSTALLMENT LOAN APPLICATION (205 ILCS 670/1 et seq)
I Agree
I Agree
I Do Not Agree
I Do Not Agree
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