Home Equity Loan Application

PBK

IF THE PURPOSE OF THIS LOAN IS FOR HOME IMPROVEMENT OR REFINANCE PLEASE CHECK THIS BOX

CREDIT DISCLOSURES: An insurance product or annuity may be offered to you. If you purchase an insurance product or an annuity: (1) The insurance product or annuity is not a deposit or other obligation of, or guaranteed by, this institution or our affiliate(s); (2) With exception of Federal Flood Insurance or Federal Crop Insurance, the insurance product or annuity is not insured by the Federal Deposit Insurance Corporation or any other agency of the United States, this institution, or our affiliate(s); and (3) In the case of an Insurance product or annuity that involves an investment risk, there is investment risk associated with the insurance product, including the possible loss of value. If an insurance product or annuity is offered we cannot condition an extension of credit on either of the following: (1) Your purchase of an insurance product or annuity from us or any of our affiliates; or, (2) Your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.
Please acknowledge receipt of this disclosure (initial)
Applicant Co-Applicant

SIGNATURES I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By signing below I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes. Unless I have purchased the insurance product(s) by mail or the Credit Disclosures are provided electronically, by signing below, I acknowledge that I have received the Credit Disclosures orally at the time I have applied for credit and fully understand the disclosures noted above. I am also being provided with a copy of these disclosures and I acknowledge receipt by my signature.”

Applicant’s Signature Date

Other Signature (Where Applicable) Date

Home Equity Loan APPLICATION
IMPORTANT: Read these Directions before completing this Application. (Check Appropriate Box) If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Section A and D. If the requested credit is to be secured, also complete the first part of Section C and Section E. If you are applying for joint credit with another person, complete all Sections except E, providing information in B about the joint applicant. If the requested credit is to be secured, then complete Section E. If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all Sections, providing the information about the person on whose alimony, support, or maintenance payments or income or assets you are relying. If the loan is to be secured, describe collateral in Section E as well. We intend to apply for joint credit (initial)					FOR CREDITOR USE Date Received_____________________ Completed Application Date __________ Action Taken Date __________________ Identification Verified _______________ State of Issuance ___________________ Expiration Date ___________________
AMOUNT REQUESTED PAYMENT DATE DESIRED PROCEEDS OF CREDIT TO BE USED FOR $
DESCRIPTION OF PROPERTY USED TO SECURE LOAN LIST ALL OWNERS ADDRESS (Street, City, State & Zip)
SECTION A - INDIVIDUAL APPLICANT INFORMATION
NAME (Last, First, Middle) EMAIL							BIRTHDATE
TELEPHONE NO.	DRIVER’S LICENSE		SOCIAL SECURITY#:		#OF DEPENDENTS:		AGES OF DEPENDENTS
ADDRESS (Street, City, State & Zip)				COUNTY		Do you Own Rent	HOW LONG
PREVIOUS ADDRESS (Street, City, State & Zip) (Complete if less than 3 years at present address)				COUNTY		Do you Own Rent	HOW LONG
EMPLOYER (Company Name & Address)							HOW LONG
BUSINESS PHONE EXT.		POSITION OR TITLE			GROSS SALARY PER MONTH
PREVIOUS EMPLOYER (Company Name & Address)							HOW LONG
NAME & ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU RELATIONSHIP TELEPHONE NO. (Include area code)
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. Alimony, child support, separate maintenance received under: Court OrderWritten AgreementOral Understanding
SOURCES OF OTHER INCOME						AMOUNT PER MONTH $
Is any income listed in this section likely to be reduced before the credit request is paid off? NoYes(Explain)						Have you ever received credit from us? NoYes When?
SECTION B - JOINT APPLICANT OR OTHER PARTY INFORMATION Complete only if: for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state.
NAME (Last, First, Middle)							BIRTHDATE
TELEPHONE NO.	DRIVER’S LICENSE		SOCIAL SECURITY NO.		# OF DEPENDENTS		AGES OF DEPENDENTS
RELATIONSHIP TO APPLICANT (if any)			ADDRESS (Street, City, State & Zip)				HOW LONG
EMPLOYER (Company Name & Address)							HOW LONG
BUSINESS PHONE EXT.		POSITION OR TITLE			GROSS SALARY PER MONTH
PREVIOUS EMPLOYER (Company Name & Address)							HOW LONG
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. Alimony, child support, separate maintenance received under: Court OrderWritten AgreementOral Understanding
SOURCES OF OTHER INCOME						AMOUNT PER MONTH $
Is any income listed in this section likely to be reduced before the credit request is paid off? NoYes(Explain)						Have Joint Applicant or Other Party received credit from us? NoYesWhen?
SECTION C - MARITAL STATUS Complete only if: for joint or secured credit, or applicant resides in a community property state relying on property located is such a state as a basis for repaying credit requested.
APPLICANT OTHER PARTY		MarriedSeparatedUnmarried(including single, divorced, and widowed) MarriedSeparatedUnmarried(including single, divorced, and widowed)

SECTION D - ASSET & DEBT INFORMATION
If Section B is completed, this section should be completed giving information about both the Applicant and Joint Applicant or Other Person.
ASSETS OWNED	(Use separate sheet if necessary)
DESCRIPTION OF ASSETS	NAME OF OWNERS		SUBJECT TO DEBT?		VALUE
CHECKING ACCT NUMBER(s) (where)
SAVINGS ACCT NUMBER(s) (where)
CERT(s) OF DEPOSIT (where)
MARKETABLE SECURITIES (Issuer, type, no. of shares)
REAL ESTATE (loc, date acquired)

CASH VALUE OF LIFE INS. (Issuer, face value)
AUTOMOBILES (make,model,year)
OTHER (list)
TOTAL ASSETS
OUTSTANDING DEBTS	(Include charge accounts, installment contracts, credit cards, rent, mortgages, etc. Use separate sheets if necessary.)
CREDITOR		ACCOUNT NUMBER	NAME IN WHICH THE ACCOUNT IS CARRIED	ORIGINAL AMOUNT	PRESENT BALANCE	MONTHLY PAYMENTS
LANDLORD OR MORTGAGE HOLDER		Rent Payment Mortgage		$ (Omit Rent)	$	$
AUTOMOBILES (describe)

CREDIT CARD DEBT

TOTAL DEBTS
Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable):
Are you obligated to make Alimony, Support or Maintenance Payments? NoYes
If yes, to (Name & Address) Amount per month $
Are you a co-maker, endorser, or guarantor of any loan or contract? NoYesIf yes, from whom? To whom?
Are there any unsatisfied judgements against you? NoYes If yes, to whom owed? Amount $
Have you been declared bankrupt in the 10 years? NoYes If yes, where? Year?
SECTION E - SECURED CREDIT
Complete only if credit is to be secured. Briefly describe the property to be given as security.
PROPERTY DESCRIPTION
NAMES & ADDRESSES OF ALL CO-OWNERS OF THE PROPERTY (If the security is real estate, give the full name of your spouse, if any)