Home Improvement Loan Application

Important information about procedures for opening a new account

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

I/We hereby make application for credit:

Individually
Jointly

If this is an application for joint credit, (please initial).

Applicant Co-Applicant Amount Requested $ Number of Monthly Payments Description

APPLICANT

Name Residential Address Years There Mailing Address City / State / ZIP Phone Email Mortgage Bank / Landlord Mtg. Payment / Rent $ Previous Address (if less than 2 yrs. at current address) Years There Date of Birth Social Security No. Personal Reference Name Personal Reference Address Current Employer Business Address Phone Position Years There Monthly Pay $ Previous Employer (if less than 2 yrs. at current employer) Years There Other Income Source Amount $

(You are not required to reveal income from child support, alimony or separate maintenance payments)

Bank Name

Account Type	ACCOUNT #	BALANCE
Checking Account	Checking Account Number	Checking Account Balance
Savings Account	Savings Account Number	Savings Account Balance
Other Account	Other Account Number	Other Account Balance

Co-Applicant

(You are not required to reveal income from child support, alimony or separate maintenance payments)

Bank Name

Account Type	ACCOUNT #	BALANCE
Checking Account	Checking Account Number	Checking Account Balance
Savings Account	Savings Account Number	Savings Account Balance
Other Account	Other Account Number	Other Account Balance

CREDIT INFORMATION (APPLICANT & CO-APPLICANT)

Show all auto loans, charge accounts, installment debts, education loans, or any other obligations for which you are singly or jointly liable or which you are authorized to use. Attach separate sheet if necessary. Failure to list open loans could disqualify this application.

Account

Indicate name(s) in which debts or accounts appear. Creditor name and address Account Number Original AMT Credit Line Unpaid Balance Monthly Payment

 Add Another Account Number Other fixed monthly obligations (including alimony and child support) description: Notes:

Information for Government Monitoring Purposes

Complete ONLY if loan for: Purchase, Refinance or Home Improvement of a dwelling

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. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all of part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this law concerning this creditor is: Federal Reserve Consumer Help, P.O. Box 1200, Minneapolis, MN 55480.

I/We certify that all statements made in this application are true and correct to the best of my/our knowledge. I/We authorize you to obtain such information as you may require concerning the statements made in this application and agree that this application shall remain the property of the lender whether or not the loan is granted. I/We authorize the Bank to provide information with respect to the loan being applied for to any person, firm, or entity, the Bank believes has a reasonable need to know such information, including the providing of payoff figures.

Thank you. If you have any questions, please contact Customer Support at 617-928-9000, during regular business hours.

Applicant Date Co-Applicant Date

Home Improvement Loan Application

Important information about procedures for opening a new account

I/We hereby make application for credit:

APPLICANT

Co-Applicant

CREDIT INFORMATION (APPLICANT & CO-APPLICANT)

Account

Information for Government Monitoring Purposes

Applicant:

Ethnicity:

Race:

Sex:

Co-Applicant:

Ethnicity:

Race:

Sex: