HELOC Application

Type of Mortgage & Terms of Loan

• Application Type *

  Individual Joint
• Amount *

Property Information & Purpose of Loan

• Subject Property Address (Street, City, State, Zip) *
• Legal Description of Subject Property (Tax Township/Lot/Block) *
• Year Built*
• Purpose of Loan *
• Are you refinancing? *

  Yes No

Contact us for information on construction loans.

• Year Acquired *
• Original Cost *
• Amount Existing Loans *
• Purpose of Refinance *
• Improvements *
  Made To be made
• Cost $ *
• Describe Improvements *

• Title is held in what Name(s) *
• Manner in which title is held *

Borrower Information

• Borrower

  Borrower's Name *
  (Include Jr. or Sr. if applicable)
• Social Security Number *
• Home Phone *
  (Include area code)
• Date of Birth *
  (MM/DD/YYYY)
• Years School *
• Marital Status
  Married Separated Unmarried (Include Single, Divorced, Widowed)
• Number of Dependents
• Ages
• Present Street Address *
• Rent Own
• Number of Years *
• Mailing Address
  (If different from Present Address)
• Former Address
  (If residing at present address for less than two years)
• Rent Own
• Number of Years

• Co-Borrower

  Co-Borrower's Name *
  (Include Jr. or Sr. if applicable)
• Social Security Number *
• Home Phone *
  (Include area code)
• Date of Birth *
  (MM/DD/YYYY)
• Years School *
• Marital Status *
  Married Separated Unmarried (Include Single, Divorced, Widowed)
• Number of Dependents
• Ages
• Present Street Address *
• Rent Own
• Number of Years *
• Mailing Address
  (If different from Present Address)
• Former Address
  (If residing at present address for less than two years)
• Rent Own
• Number of Years

Employment Information

• Borrower

  Name & Address of Employer *
• Self Employed
• Years on this job *
• Years employed in this line of work/profession *
• Position/Title/Type of Business *
• Business Phone *
  (Include area code)
• Name & Address of Previous Employer
  (If employed in current position for less than two years or if currently employed in more than one position)
• Self Employed
• Dates (From - To)
• Gross Monthly Income $
• Position/Title/Type of Business
• Business Phone
  (Include area code)
• Name & Address of Previous Employer
• Self Employed
• Dates (From - To)
• Gross Monthly Income $
• Position/Title/Type of Business
• Business Phone
  (Include area code)

• Co-Borrower

  Name & Address of Employer *
• Self Employed
• Years on this job *
• Years employed in this line of work/profession *
• Position/Title/Type of Business *
• Business Phone *
  (Include area code)
• Name & Address of Previous Employer
  (If employed in current position for less than two years or if currently employed in more than one position)
• Self Employed
• Dates (From - To)
• Gross Monthly Income $
• Position/Title/Type of Business
• Business Phone
  (Include area code)
• Name & Address of Previous Employer
• Self Employed
• Dates (From - To)
• Gross Monthly Income $
• Position/Title/Type of Business
• Business Phone
  (Include area code)

Monthly Income & Combined Housing Expense Information

Gross Monthly Income

** Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.

Combined Monthly Housing Expense

Assets & Liabilities

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required.

If the Co-Borrower section was completed about a nonapplicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

• Completed *

  Individual Joint

• Assets

  Cash deposit toward purchase held by
• Cash or Market Value

List checking & savings accounts below

• Name & Address of Bank, S&L, or Credit Union
• Account Number
• Amount
• Name & Address of Bank, S&L, or Credit Union
• Account Number
• Amount
• Name & Address of Bank, S&L, or Credit Union
• Account Number
• Amount
• Name & Address of Bank, S&L, or Credit Union
• Account Number
• Amount
• S & Bonds
  (Company Name, Number & Description)
• Value
• Life insurance net cash value face amount
• Cash Value
• Subtotal Liquid Assets
• Real Estate Owned
  (Enter market value from schedule of real estate owned)
• Vested interest in retirement fund
• Net Worth of Business(es) Owned
• Automobiles owned
  (Make & Year)
• Value
• Other Assets
  (Itemize)
• Value
• Total Assets Value

Liabilities

Liabilities and Pledged Assets. List the creditor's name, address, and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.

• Alimony/Child Support/Separate Maintenance Payments Owed to:
• Monthly Payment
• Job-Related Expense
  (Child care, union dues, etc.)
• Total Monthly Payments
• Total Liabilities
• Net Worth
  (Total Assets minus Total Liabilities)

Schedule of Real Estate Owned

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

• Alternate Name
• Creditor Name
• Account Number

Declarations

Acknowledgment & Agreement

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its services, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer credit reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgment. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.

Type your name in the box below to represent your electronic signature

• Applicant Signature *
• Co-Applicant Signature *
• Bank Representative

Disclosure*

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