Home Equity Loan 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.

TYPE OF ACCOUNT REQUESTED

Check one to indicate the type of account you are requesting. Note: Married applicants may apply for separate accounts.



TERMS REQUESTED
%
Type of Loan:
/
Purpose:
 
COLLATERAL PROPERTY
Mortgage Holder  
INDIVIDUAL APPLICANT INFORMATION
, : ,
Wages, Salary, Commissions:
/ month
/ month

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


Other Income  
/ Month
Marital Status:
JOINT APPLICANT OR OTHER PARTY INFORMATION

Provide the information in this section if joint credit, or the individual applicant is relying on the income of others as a basis for repayment, or the individual applicant lives in a community property state or is relying on property located in a community property state as a basis for repayment of the credit requested.

, : ,
Wages, Salary, Commissions:
/ month
/ month

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


Other Income
/ Month
Marital Status:
GENERAL INFORMATION

If you or a joint applicant or other party answers "yes" to any of the following questions, please explain in the space provided.

Are you a guarantor or co-maker of any leases, contracts or debts?

Applicant:      

Joint Applicant / Other Party:     


Are there any suits or judgments pending against you?

Applicant:     

Joint Applicant / Other Party:     


Have you been declared bankrupt in the last 10 years?

Applicant:     

Joint Applicant / Other Party:     

PREVIOUS CREDIT REFERENCES

Describe any previous debt obligations. Please mark Applicant-related information with an "A".

Description Amount Date Paid
ASSET AND DEBT INFORMATION

If "Joint Applicant or Other Party Information" section was completed above, this section should be completed giving information about both the Applicant and the Joint Applicant or Other Party. Attach additional sheets if necessary.

ASSETS

DESCRIPTION OF CURRENT ASSETS NAME(S) OF OWNER(S) SUBJECT TO DEBT?: VALUE
Checking Accounts (Institution, Account Number)  
Is this checking account subject to debt?
Is this checking account subject to debt?
Savings Accounts (Institution, Account Number)  
Is this savings account subject to debt?
Is this savings account subject to debt?
Automobiles (Make, Model, Year)  
Is this automobile subject to debt?
Is this automobile subject to debt?
Marketable Securities (Issuer, Type, Number of Shares)  
Is this security subject to debt?
Is this security subject to debt?
 
Is this insurance policy subject to debt?
 
Is this real estate subject to debt?
Other Assets (Describe)  
Is this asset subject to debt?
Is this asset subject to debt?

OUTSTANDING DEBTS

(Include all charge accounts, installment contracts, credit cards, rents, mortgages and other obligations.)

CREDITOR ACCOUNT NUMBER NAMES IN WHICH THE ACCOUNT IS CARRIED ORIGINAL AMOUNT PRESENT BALANCE MONTHLY PAYMENTS
Auto Loans
Credit or Charge Cards
Landlord or 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 connectino 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.

We intend to apply for joint credit. (initials)

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.

Applicant Date
Joint-Applicant Date