Home Equity Line of Credit Application

Type of Mortgage and Terms of Loan

Are you applying for joint credit? No Yes

Initials Joint Initials Total Loan Amount Purpose of Loan

Borrower Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Phone Number E-mail Address

Marital Status Married Separated Unmarried (includes single, divorced and widowed)

Housing

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

Mailing Address City State Zip Code

Do you own or rent this property? Own Rent Other

Explain Estimated Value of Property

Have you lived here for two or more years? Yes No

Previous Home Address City State Zip Code

Borrower Employment Information

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

Does the second employer provide at least a total of the last 2 years of employment? (No if unemployed) Yes No

Previous Employer 2

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

Other Income

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

Please Note: Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Sources of Other Income Amount Per Month

Co-Borrower Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Phone Number E-mail Address

Co-Borrower Marital Status Married Separated Unmarried (includes single, divorced and widowed)

Co-Borrower 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 Estimated Value of Property

Have you lived here for two or more years? Yes No

Previous Home Address City State Zip Code

Co-Borrower Employment Information

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

Does the second employer provide at least a total of the last 2 years of employment? (No if unemployed) Yes No

Previous Employer 2

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

Other Income

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

Please Note: Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Sources of Other Income Amount Per Month

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.

Checking or Savings Accounts

Account Number	Institution	Cash or Market Value
Account Number	Institution Name	Total Value
		Subtotal Liquid Assets

Real Estate Owned

Property Address Type of Property Estimated Market Value Mortgage Balance Mortgage Payments Property Taxes Insurance

Subtotal Real Estate Market Values

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

Liability

Creditor Creditor/Company Owed Monthly Payment Unpaid Balance

Alimony/Child Support/Separate Maintenance

Expense	Total Owed	Monthly Payment
Alimony	Total Owed	Monthly Payment
Child Support	Total Owed	Monthly Payment
Job-Related Expenses (child care, union dues, etc.)		Monthly Payment
	Total Liabilities	Total Monthly Payments

Net Worth

Net Worth (Assets minus Liabilities)

Borrower Declarations

Are there any outstanding judgments against you? Yes No

Explain

Have you been declared bankrupt within the past 10 years? Yes No

Explain

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 10 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 co-maker or endorser on a note? 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 Declarations

Are there any outstanding judgments against you? Yes No

Explain

Have you been declared bankrupt within the past 10 years? Yes No

Explain

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 10 years? Yes No

Explain

Are you a party to a lawsuit? Yes No

Explain

Are you obligated to pay alimony, child support, or separate maintenance? Yes No

Explain

Are you a co-maker or endorser on a note? 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?

Disclosures

Before submitting your application, please click the hyperlinks below to view required disclosures.

E-Sign Agreement
Please check here that you have successfully viewed the E-Sign Agreement. (You must read the document to enable this checkbox.)

Early HELOC Disclosure
Please check here that you have successfully viewed the Early HELOC Disclosure. (You must read the document to enable this checkbox.)

HELOC Booklet
Please check here that you have successfully viewed the HELOC Booklet. (You must read the document to enable this checkbox.)

Privacy Notice
Please check here that you have successfully viewed the Privacy Notice. (You must read the document to enable this checkbox.)

We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close. You can pay for an additional appraisal for your own use at your own cost.

Acknowledgement

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.

Borrower's Signature Date

Co-Borrower's Signature Date

Loan Originator's Signature Date Loan Originator's Name (print or type) Loan Originator's Identifier Loan Originator's Phone Number (including area code) Loan Origination Company's Address

Loan Origination Company's Name: First National Bank Minnesota
Loan Origination Company NMLS Identifier: 433970

Type the numbers you see above:

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