Apply online for a title loan

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 Highland 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 Highland Quick Cash, Inc. to the extent not prohibited by law.  I/We
understand that Highland 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 Highland Quick Cash, Inc.
I Agree
I Agree
I Do Not Agree
I Do Not Agree
Highland Quick Cash, Inc. 12589 State Route 143 / Highland, IL 62249 Ph 618-651-1600

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