Home Equity Loan Application

Loan Type

Loan you are requesting Equity Line Fixed Rate Equity Loan

Are you applying for joint credit? Yes No

Total Loan Amount Length of Account Term Loan Purpose

Information About Collateral Property

Property Address City State Zip Code Purchase Date Current Value Outstanding First Mortgage Balance Year Built Name of Mortgage Holder Address of Mortgage Holder City State Zip Code Mortgage Holder Telephone Account No.

Occupancy Primary Residence Secondary Residence

Type of Property Single Family-Detached Single Family-Attached 2-4 Family Condo P.U.D

Borrower Information

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

Marital Status Single Married Separated Divorced Widowed

Housing

Current Home Address City State Zip Code Years There

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

Previous Home Address City State Zip Code Years There

Co-Borrower Information

First Name Middle Initial Last Name Social Security Number Birth Date Phone Number Number of Dependents

Marital Status Single Married Separated Divorced Widowed

Housing

Current Home Address City State Zip Code Years There

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

Previous Home Address City State Zip Code Years There

Borrower Employment Information

Is the borrower employed? Employed Retired

Name of Current Employer Employer's Address City State Zip Code Years There Employer's Phone Number Monthly Income Position or Title Other Income Gross Monthly Income

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

Previous Employer 1

Name of Previous Employer Employer's Address City State Zip Code Position or Title Monthly Income Years There

Previous Employer 2

Name of Previous Employer Employer's Address City State Zip Code Position or Title Monthly Income Years There

Co-Borrower Employment Information

Is the borrower employed? Employed Retired

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

Name of Previous Employer Employer's Address City State Zip Code Position or Title Monthly Income Years There

Previous Employer 2

Name of Previous Employer Employer's Address City State Zip Code Position or Title Monthly Income Years There

Assets

Checking Accounts

Account Number	Institution	Amount / Value
Account Number	Institution Name	Total Value

Savings Accounts

Account Number	Institution	Amount / Value
Account Number	Institution Name	Total Value

Stocks and Bonds

Description	Company	Amount / Value
Description	Company Name	Total Value
		Subtotal Liquid Assets

Investments

Assets	Value
Real estate owned (market value)	Real estate owned (market value)
Net Worth of business(es) owned	Net Worth of business(es) owned

Assets Total

Liabilities

Credit Cards

Account Number	Lender	Monthly Payments	Unpaid Balance
Account Number	Lender	Monthly Payments	Unpaid Balance

Installment Loans - Including Auto

Account Number	Institution	Monthly Payments	Unpaid Balance
Account Number	Lender	Monthly Payments	Unpaid Balance

Mortgage on Collateral Property

Account Number	Institution	Monthly Payments	Unpaid Balance
Account Number	Lender	Monthly Payments	Unpaid Balance

Second Mortgage

Account Number	Institution	Monthly Payments	Unpaid Balance
Account Number	Lender	Monthly Payments	Unpaid Balance

Other Obligations

Account Number	Institution	Monthly Payments	Unpaid Balance
Account Number	Lender	Monthly Payments	Unpaid Balance

Total Monthly Payments

Total Liabilities

Schedule of Real Estate Owned

Real Estate

Property Address City State Zip Code Type of Property Present Market Value Amount of Mortgages & Liens

Monthly Gross Rental Income Monthly Mortgage Payments Monthly Insurance, Maintenance, Taxes & Misc.

Totals

Real Estate Market Value Mortgages & Liens

Monthly Totals

Gross Rental Income Mortgage Payments Insurance, Maintenance, Taxes & Misc.

CItizenship and General Information

Borrower

Are you a U.S. citizen? Yes No

Are you a resident alien? Yes No

Are you a non-resident alien? Yes No

Any garnishment, judgement, repossession, foreclosure or other legal actions filed against you in the last 7 years? Yes No

Explain

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

Explain

Are you a co-maker or endorsed on a Note? Yes No

Explain

Co-Borrower

Are you a U.S. citizen? Yes No

Are you a resident alien? Yes No

Are you a non-resident alien? Yes No

Any garnishment, judgement, repossession, foreclosure or other legal actions filed against you in the last 7 years? Yes No

Explain

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

Explain

Are you a co-maker or endorsed on a Note? Yes No

Explain

Acknowledgement & 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 of criminal penalties including, but nor limited to, fine or imprisonment or both under the provisions of Title 18. United States Cod Sec. 1301. et seq.; (2) the loan requested pursuant to this application (the loan) will be secured by a mortgage or a deed of trust on the property described herein;(3) the property will not be used for any illegal or prohibited purpose of 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 herein;(6) any owner or servicer of the loan may verify or re-verify any information contained in the application from any source named in this application, and Lender, it’s successors or assigns may retain the original and/or an electronic record of this application, even if the loan is not approved;(7) the Lender and it’s agents, brokers, insurers, servicers, successors and assigns may continuously rely on this information contained in the application, and I am obligated to amend and/or supplement the information provided in this application of 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 owner or servicer of the Loan may, in addition to any other rights and remedies that if 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 it agents, brokers, insurers, servicers, successors or assigns has may 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 my 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.

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

Borrower's Signature Date

Co-Borrower's Signature Date

Information for Government Monitoring Purposes

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender’s compliance with equal credit opportunity, fair housing and home mortgage, disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race or sex, under Federal regulations, this lender is required to note this information on the basis of visual observation or surname. If you do not wish to furnish this information, please check the box below. [Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.]

I wish to furnish this information I do not wish to furnish this information

Ethnicity Hispanic or Latino Not Hispanic of Latino

Race American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian White Black or African American

Sex Female Male

Co-Borrower: I wish to furnish this information Co-Borrower: I do not wish to furnish this information

Ethnicity Hispanic or Latino Not Hispanic of Latino

Race American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian White Black or African American

Sex Female Male

Type the numbers you see above:

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