Home Equity Application

IMPORTANT APPLICANT INFORMATION:

Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.


* Required

Type of Account Requested
 Individual Account - relying solely on my income or assets
 Individual Account - relying on my income or assets as well as income from other sources
 Joint Account
Terms Requested



 Fixed
 ARM(type)


 Home Improvement
 Pay Debt
 Other



Collateral Property












Individual Applicant Information
















Current Employer












Previous Employer










Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered.


 Court Order
 Written Agreement
 Oral Understanding



 Married
 Seperated
 Unmarried (includes single divorced and widowed)
Joint Applicant or Other Party Information















Current Employer









Previous Employer










Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered.


 Court Order
 Written Agreement
 Oral Understanding



 Married
 Separated
 Unmarried (includes single divorced and widowed
General Information
Are you a guarantor or co-maker of any leases, contracts or debts?


 Yes
 No

 Yes
 No

Are there any suits or judgments pending against you?


 Yes
 No

 Yes
 No

Have you been declared bankrupt in the last 10 years?


 Yes
 No

 Yes
 No

Previous Credit References




 Yes
 No




 Yes
 No
Asset & Debt Information

Assets


Checking Account




Savings Account




Automobiles (Make, Model, Year)




Marketable Securities




Life Insurance




Other Real Estate




Other Assets






Outstanding Debts

Include all charge accounts, installment contracts, credit cards, rent, mortgages and other obligations.

Auto Loans






Credit or Charge Cards






Landlord of Mortgage Holder on other Real Estate






Other






Total Debts




Maine Residents: A consumer report may be ordered in connection with your application. Upon your request, we will inform you whether or not a report was ordered. If a report was ordered we will tell you the name and address of the consumer reporting agency that provided the report.

New York Residents: A consumer report may be ordered in connection with your application. Upon your request, we will inform you whether or not a report was ordered. If a report was ordered we will tell you the name and address of the consumer reporting agency that provided the report. Subsequent reports may be ordered or utilized in connection with an update, renewal or extension of credit for which you have applied.

Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Married Wisconsin Residents: No provision of any marital property agreement, unilateral statement under Wisc. Statutes §766.59 or a court decree under Wisc. Statutes §766.70 adversely affects the interest of the lender unless the lender, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the lender is incurred.

 Notice - Joint Credit

I certify that everything I have stated in this application and on any attachments is correct. Lender may keep this application whether or not it is approved. By signing below, I authorize Lender to check my credit and employment history, to have a consumer credit report prepared on me for the purpose of evaluating this application for credit, and to answer questions others may ask Lender about my credit record with Lender. I understand that I must update this credit information at Lender's request and if my financial condition changes.

Please click here to review and download the required disclosures:
Disclosures

I acknowledge receipt of the Home Equity Brochure, lender's Home Equity disclosure statement, and Insurance Disclosure for Credit Application on today's date.






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