Quickstop Loan Application Form

Customer Information
Loan Application Form
Need Assistance? Contact us at 223-2274 or 280-2274

Customer Information
Customer Type
 This will be my first loan at Quickstop  I’ve had a Quickstop loan in the past

Referred By Whom?
Samantha Sammuels
First Middle Last
Must be a current Quickstop Customer.

PERSONAL INFORMATION
Date of Birth Gender Purpose of loan
22/08/1997 Female Personal Expenses
DD/MM/YYYY Purpose

Nearest Branch to You Preferred Means of Contact

Belize City  Phone Call  SMS  Email  Whatsapp
Branch
Select all that apply

Name..
Tamara Renita Williams
First Middle Last

Address.
95 Cor Mahogany St & Flamboyant
Address Line 1

Address Line 2

Belize
City

a. Time Living At b. Time Living at Address Residential Status

Address Months Renting
8
Enter number

Email Primary Phone #

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trwilliams3333@gmail.com 6368526

Secondary Phone #

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Reference Information
REFERENCE INFORMATION
References are requested in the event that you are unreachable.
Reference #1
Tristan Williams
First Last
Must be a family member (Mother, Father, Spouse or live in significant other, Grandmother, Grandfather,
Sibling)
Reference #1 Address
Santa Rosa
Address Line 1

Address Line 2

Dangriga
City

Reference #1 Ph.#
6041492

Reference #2
Zinedin Moguel
First Last
May be a family member, friend or coworker.
Reference #2 Address
Kings Park
Address Line 1

Address Line 2

Belize
City

Reference #2 Ph.#
6207446

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Employment Information
EMPLOYMENT INFORMATION
Employer Time Employed
Ready Call Center 1 - 2 Years
Place of work Eg. (Quickstop Personal Finance Time Employed
Center)
Position Employer Ph.#
Customer Service Representative 6058960
Job Title
Salary / Wage Pay Period
700 Biweekly
Per Pay Period

DOCUMENTS
Job Letter or Payslip
Tamara_Williams_1589066038.pdf
Only clear legible images will be accepted
Social Security Card / Passport / Voters ID
97665574_814863039039117_6611032791234641920_n.jpg
Only clear legible images will be accepted
Utility Bill
E-Bill.PDF
Contact us for more info if the bill is not in your name. Only clear legible images will be accepted

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Application Review/Submit
Your application is almost complete.

Please review and verify that all of your information is correct.

Click the "BACK" button to make changes to your application or click the "SUBMIT" if there are no
changes to be made.

Customer Type: I’ve had a Quickstop loan in the past

Referred By Whom: Samantha Sammuels

Date of Birth: 22/08/1997

Gender: Female

Purpose of Loan: Personal Expenses

Nearest Branch to you:Belize City

Preferred Means of Contact:Phone Call, Whatsapp, SMS

Name: Tamara Renita Williams

Address:95 Cor Mahogany St & Flamboyant, Belize

Time living At Address:8

Time living At Address: Months

Residential StatusRenting

Email: trwilliams3333@gmail.com

Primary Phone Number: 6368526

Secondary Phone Number:

Reference #1 Name: Tristan Williams

Reference #1 Address: Santa Rosa, Dangriga

Reference #1 Ph#: 6041492

Reference #2 Name:Zinedin Moguel

Reference #2 Ph#:6207446

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Employer: Ready Call Center

Positions: Customer Service Representative

Employer Ph#: 6058960

Salary/Wage: 700

Pay Period: Biweekly

Terms of Service
Correct Information

I agree that to the best of my knowledge the above information is accurate and can be verified with the
Credit Master Systems and/or any third party.

Signature

 Please be aware that your signature at the end of this form will permit us to perform a credit check
with Credit Master Systems.
 By signing this application, you certify all information is true and correct to the best of your
knowledge.

Marketing

You hereby automatically subscribe to our marketing efforts via email, text, sales calls, sms blasts, direct
mail, whatsapp messages, social media, fax etc. via the information provided in this application. The option
to unsubscribe is available to you after receiving one or all our of our marketing materials.

Banking Authorization

Please have banking information available for when our agent contacts you.

Hereby authorize Quickstop Personal Finance Center to initiate credit entries to my account listed in Table
1 below for loans processed on my behalf over the phone. This authorization is to remain in full force and
effect until Quickstop Personal Finance Center has received written notification from me in writing to cancel
it in such time and in such manner as to afford Quickstop Personal Finance Center and THE FINANCIAL
INSTITUTION a reasonable opportunity to act on it.

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Signature

Please proceed to sign this document then click submit at the bottom

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