HELOC Application2

4. ASSET AND DEBT INFORMATION

Please note: An officer will obtain a credit report to verify all debts.

Do you have a current mortgage?*

YesNo
Who is your mortgage with?*
What was the appx. original balance?*
What is the current balance?*

5. EMPLOYMENT INFORMATION
1st Employer - Borrower

Current
Borrower Current Employer *
Borrower Current Employer Address (Street, City, State, Zip)*
Number of years at this Employer*
Phone number of Employer*
Position/Title*
Gross Monthly Salary/Comm.*
Please enter amount before taxes
1st Employer - Co Borrower

Current
Co-Borrower Current Employer*
Co-Borrower Current Employer Address (Street, City, State, Zip)*
Number of years at this Employer*
Phone Number of Employer*
Position/Title*
Gross Monthly Salary/Comm.*
Please enter amount before taxes
6. OTHER INCOME

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.

If this does not apply to you, you may skip this section.
Borrower - Source
example: Alimony, Child Support, ect.
Borrower - Amount received per month
Alimony, child support, separate maintenance received under:

Court OrderWritten AgreementOral Understanding
Co-Borrower - Source
Co-Borrower - Amount received per month
Alimony, child support, separate maintenance received under:

Court OrderWritten AgreementOral Understanding

8. PROPERTY INFORMATION
Property Description*
example: Single Family Residence on 5 acres with 3 bed, 2 bath
Residential Dwelling

Type option 1
Property Address of Collateral (Street, City, State, Zip)*
Primary Use of Property

Consumer
Current Property Owner(s) Name(s)*
example: John and Jane Doe, A Married Couple
CERTIFICATIONS, AUTHORIZATIONS AND SIGNATURES

You certify that everything you have stated in this Credit Application and on any other documents submitted to us are true and correct to the best of your knowledge. You understand that you must update the information contained in this Credit Application if either your financial condition materially changes or we make a request to you orally or in writing. You understand that we will retain this Credit Application whether or not it is approved.

You authorize us to request one or more consumer reports, to check and verify your credit and employment history, and to answer questions others may ask us about our credit experience with you.

In order to provide you with the best possible service in our ongoing business relationship with you, you acknowledge that we may contact you for ordinary business purposes using any of the telephone numbers or email addresses listed on this Credit Application or that you subsequently provide us in connection with your credit account - regardless of whether the telephone number we use is assigned to a paging service, cellular telephone service, specialized mobile radio service, other radio common carrier service or any other service for which you may be charged for the call. You further acknowledge that we may contact you through the use of voice, voicemail, or text messaging and that we may use prerecorded or artificial voice messages or automatic telephone dialing systems.

Electronic Signature. You further agree that you have signed this Credit Application with one or more electronic signatures. You intend your electronic signature to have the effect of your written ink signature. You viewed and read the entire Credit Application and notices before you signed it. You received a paper copy of this Credit Application after it was signed. You understand that this Credit Application is in the electronic form that we will keep. We may rely on, and enforce, this Credit Application in the electronic form or as a paper version of the electronic form.

Notice: It is a federal crime punishable by fine, 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 1001, et seq.
E-Signature box

Type option 1
PLEASE REVIEW OUR HELOC DISCLOSURES AND HELOC BOOKLET BEFORE SUBMITTING
Borrower Signature*

Clear
Please upload a copy of your ID*

Cancelof
Date

MonthDayYear
Date
Co-Borrower Signature*

Clear
Please upload a copy of your ID*

Cancelof
Date

MonthDayYear
Date
Should be Empty:

	Bank Name	Current amount in account
Account 1
Account 2
Account 3
Account 4