Open End Lending Plan Advance Request

Type of Advance Requested *

Automobile Loan

Boat Loan

RV Loan

Signature Loan

Equi-Fix Home Equity Loan

EquiFlex Home Equity Line of Credit

Holiday Loan

Vacation Loan

Share Secured Loan

Stock Secured Loan

Overdraft Protection

Option Two

Option One

Option Two

Option One

Option Two

Option One

Are you requesting a pre-approval or an actual advance? *

Actual Advance

Pre-Approval

Is this advance request for refinancing an existing loan? *

Yes

No

Advance Purpose *

New Vehicle

Used Vehicle

Enterprise/Qside Promo

Large Purchase

Debt Consolidation

Tuition

Vacation

Car Repairs

Home Improvement

Event

Holiday Shopping

Taxes

Insurance

Appliance/Furnishings

Overdraft Protection

Other

Is there a Joint Borrower for this advance request? *

Yes

No

How did you hear about Qside's advance products? *

Website

Qside Email Message

Qside Newsletter

Newspaper Ad

Direct Mail Letter or Postcard

Another Qside Member

Qside Member Service Representative

Other

Name *

First Name

Last Name

Home Phone *

(###)

###

####

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Living Situation *

Own

Rent

Living with Parents/Family

Address of Nearest Living Relative *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

Employer's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Property Type

1 Family

2 Family

3 Family

4 Family

Condominium

Planned Unit Development

Property is my Primary Residence

Yes

No

Name

First Name

Last Name

Home Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country