Home Equity Line of Credit Application

Required Field

Type of Mortgage and Terms of Loan

Are you applying for joint credit?

Yes
No

Total Loan Amount

Property Information & Purpose of Loan

Name of Title Holder Manner in Which Title is Held Subject Property Address City State Zip Code Purpose of Loan

What is the property used for?

Primary Residence
Secondary Residence
Investment

Will this be used for improvements?

Yes
No
Improvements have already been made.

Describe Improvements Total Cost of Improvements

Borrower Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Home Phone Number Work Phone Number Cell Phone Number E-mail Address Please do NOT email me important news and updates.

Housing

Home Address City State Zip Code Mailing address is different than street address. Mailing Address City State Zip Code

Do you own or rent this property?

Own
Rent
Other
Explain

Residency Start Date Monthly Mortgage or Rent Payment

Have you lived here for two or more years?

Yes
No

Previous Home Address City State Zip Code

Did you own or rent this property?

Own
Rent
Other
Explain

Residency Start Date Monthly Mortgage or Rent Payment

Marital Status

Single
Married
Separated
Divorced
Widowed

Employment Information

Borrower Employment

Is the borrower employed?

Employed
Not Employed

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Have you worked here for more than two years? (No if unemployed)

Yes
No

Previous Employer 1

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Previous Employer 2

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Co-Borrower's Employment Information

Is the co-borrower employed?

Employed
Not Employed

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Have you worked here for more than two years? (No if unemployed)

Yes
No

Previous Employer #1

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Previous Employer #2

Employment Start Date Position or Title Gross Monthly Income Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Monthly Income and Combined Housing Expense Information

Monthly Income Source
Borrower
Co-Borrower
Line Total

Base Employment Income
Co-Borrower Base Employment Income
Total Base Employment Income

Overtime
Co-Borrower Overtime
Total Overtime

Bonuses
Co-Borrower Bonuses
Total Bonuses

Commissions
Co-Borrower Commissions
Total Commissions

Dividends/Interest
Co-Borrower Dividends/Interest
Total Dividends/Interest

Net Rental Income
Co-Borrower Net Rental Income
Total Net Rental Income

Other Income
Co-Borrower Other Income
Total Other Income

before completing, see the notice in "describe other income" below

Income Total
Co-Borrower Income Total
Total Income Total

Other 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.

Income Proprietor
Description
Monthly Amount

Income Proprietor
Description
Monthly Amount

 

Combined Monthly Housing Expenses

Monthly Expense Source
Present

Rent

First Mortgage (P&I)

Other Financing (P&I)

Hazard Insurance

Real Estate Taxes

Mortgage Insurance

Homeowner Association Dues

Other

Total

Assets

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 non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

Checking or Savings Accounts

Account Number
Institution
Cash or Market Value

Account Number
Institution Name
Total Value

 

Stocks, Bonds, and Mutual Funds

Description
Company
Cash or Market Value

Description
Company Name
Total Value

 

Subtotal Liquid Assets

Investments

Assets
Cash or Market Value

Real estate owned (enter market value from schedule of real estate owned)

Vested interest in retirement fund

Net Worth of business(es) owned (attach financial statement)

Automobiles owned

Make
Model
Year
Cash or Market Value

Make
Model
Year
Total Value

 

Other Assets (itemize)

Asset Description
Cash or Market Value

Asset Description
Total Value

 

Assets Total

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 non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

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.

Liability

Unpaid Balance Monthly Payment Name of Liability Owner Account Number

 Add Another Liability

Alimony/Child Support/Separate Maintenance

Name of Party Paid to Total Owed Job-Related Expenses(child care, union dues, etc.) Total Monthly Payments Total Liabilities Net Worth (Assets minus Liabilities)

Schedule of Real Estate Owned

Real Estate

Property Address City State Zip Code Type of Property Present Market Value Amount of Mortgages & Liens Gross Rental Income Net Rental Income Mortgage Payments Insurance, Maintenance, Taxes & Misc.

 Add Another Property

Declarations

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

Alternate Name
Creditor Name
Account Number

 

Borrower

Are there any outstanding judgments against you?

Yes
No
Explain

Have you been declared bankrupt within the past 7 years?

Yes
No
Explain

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

Yes
No
Explain

Are you a party to a lawsuit?

Yes
No
Explain

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes" provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.)

Yes
No
Explain

Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If "Yes", give details as described in the preceding question.

Yes
No
Explain

Are you obligated to pay alimony, child support, or separate maintenance?

Yes
No
Explain

Are you a U.S. citizen?

Yes
No

Are you a permanent resident alien?

Yes
No
Explain

Do you intend to occupy the property as your primary residence?

Yes
No

Have you had an ownership interest in a property in the last three years?

Yes
No

What type of property did you own? How did you hold the title to the home?

Co-Borrower

Are there any outstanding judgments against you?

Yes
No
Explain

Have you been declared bankrupt within the past 7 years?

Yes
No
Explain

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

Yes
No
Explain

Are you a party to a lawsuit?

Yes
No
Explain

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes" provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.)

Yes
No
Explain

Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If "Yes", give details as described in the preceding question.

Yes
No
Explain

Are you obligated to pay alimony, child support, or separate maintenance?

Yes
No
Explain

Are you a U.S. citizen?

Yes
No

Are you a permanent resident alien?

Yes
No
Explain

Do you intend to occupy the property as your primary residence?

Yes
No

Have you had an ownership interest in a property in the last three years?

Yes
No

What type of property did you own? How did you hold the title to the home?

Acknowledgement & Agreement

Each of the undersigned specifically represent to Valley Bank of Nevada that: (1) the information provided in this application is true and correct as of the date of the application and that any intentional or negligent misrepresentation of the information contained in this application may result in civil liability including monetary damages due to reliance upon any misrepresentation under the provisions of Title 18, United States Code, Sec. 1001 et seq.; (2) the loan requested 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 purposes of obtaining a home equity loan or home equity line of credit; and (5) the property will be occupied as indicated in this application. By submitting this application as an "electronic record" containing my "electronic signature" as those terms are defined by applicable federal and state laws, shall be effective, enforceable, and valid as if a paper version of this application were delivered to Valley Bank of Nevada containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that Valley Bank of NV, or any servicers or successors, may verify information contained in this application or obtain any information or data relating to this loan application through any source deemed necessary, including a consumer credit 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.

Borrower's Signature Date Co-Borrower's Signature Date