Line of Credit Application



Is this an individual
or joint loan?
Individual Joint
Primary Borrower Information
First Name:
MI:
Last Name:
Date of Birth: / / (MM/DD/YYYY)
Social Security Number: - -
E-Mail Address:
Current Address:
City:
State:
Zip Code: -
Current Home Phone Number: - -
Length at Current Address: Years   Months
Mailing Address: (if different from current address)
Former Address: (if less than 3 years at current address)
Current Employer:
Current Job Title:
Length of Employment: Years   Months
Current Work Address:
City:
State:
Zip Code: -
Current Work Phone Number: - -   Ext:
Former Employer: (if less than 3 years at present employer)
Former Job Title:
Former Work Address:
City:
State:
Zip Code: -
Length of Employment
with Former Employer:
Years   Months

Monthly Income

PRIMARY BORROWER

Base Employ Income: $
Other Income: $
Description:
Total Income: $

Property and Loan Information
Line Requested: $
Is this an increase in a present line? Yes   No
If so, please enter account number:
Type of Loan Line of Credit

TELL US ABOUT YOUR BANK ACCOUNTS

PRIMARY BORROWER

Checking Account Balance: $   Bank/Institution Name:
Savings Account Balance: $   Bank/Institution Name:
Rent/Mortgage Payment: $   Bank/Institution Name:
Auto Loan Balance: $   Bank/Institution Name:
Credit Card Balance: $   Bank/Institution Name:
Other: $   Bank/Institution Name:

Disclaimer
The annual percentage rate is based on the value of an index. The index is the highest domestic prime rate published in the "Money Rate" section of The Wall Street Journal. To determine the annual percentage rate that will apply to your line, we subtract a margin from the value of the index equal to 0.25 of a percentage point. Changes in the index will take effect monthly on the first day of the month for the index published on the 15th day of the preceding month. The annual percentage rate can change monthly. The maximum ANNUAL PERCENTAGE RATE that can apply is 24% per annum or the highest lawful rate, whichever is less. Except for this 24% rate "cap", there is no limit on the amount by which the rate can change in any one-year period. For a copy of our complete disclosure, please contact one of our offices.