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Home Equity Application

IMPORTANT APPLICANT INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.
 
TYPE OF ACCOUNT REQUESTED
Check one to indicate the type of account you are requesting. note: Married applicants may apply for separate accounts.
Joint Account      Individual Account - Relying solely on my income and assets.
Individual Account - Relying only income and assets and as well income or assets of another.
*required fields
TERMS REQUESTED
Amount *$      Interest Rate %    
Type of Loan: Term Loan    Line of Credit     Other
No.of Months    Payment $ /    
Purpose: Home Improvement    Pay Debt:     Other:
 
COLLATERAL PROPERTY
Address   
Year Built    Date Purchased    Present Value    Balance Owing
Title in Name(s) of:
Address of Title Holder:
Name and Address of Insurance Holder:
Mortgage Holder Name   Address
Phone Number    Account No.
 
INDIVIDUAL APPLICANT INFORMATION
Name*    Birthdate    Social Security No.*
Address *(Street, City, State, Zip)
County    Drivers License No.
Home Phone*    Business Phone
No. of Dependents    Ages of Dependents
Employer/Self Employed    Position   Years Employed
Employer's Address
Wages, Salary, Commissions      Gross $ /month    Net $ /month    How Often Paid
Previous Employer    Position    Years Employed
Previous Employer's Address
Name and Address of Applicant's Nearest Relative
Relationship
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered. Alimony, child support, separate maintenance received pursuant to:
Court Order    Written Agreement    Oral Understanding
Other income: Source    Amount /Month $
Marital Status    Married    Separate    Unmarried (includes single, divorced and widowed)
 
JOINT APPLICANT OR OTHER PARTY INFORMATION
Provide the information in this section if joint credit, or the individual applicant is relying on the income of others as a basis for repayment, or the individual applicant lives in a community property state as a basis for repayment of the credit requested.
Name    Birthdate    Social Security No.
Address (Street, City, State, Zip)
County    Drivers License No.
Home Phone    Business Phone
No. of Dependents    Ages of Dependents
Employer/Self Employed    Position   Years Employed
Employer's Address
Wages, Salary, Commissions      Gross $ /month    Net $ /month    How Often Paid
Previous Employer    Position    Years Employed
Previous Employer's Address
Name and Address of Applicant's Nearest Relative
Relationship
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered. Alimony, child support, separate maintenance received pursuant to:
Court Order    Written Agreement    Oral Understanding
Other income: Source    Amount /Month $
Marital Status    Married    Separate    Unmarried (includes single, divorced and widowed)
 
GENERAL INFORMATION
If you or a joint applicant or other party answers "yes" to any of the following questions, please explain in the space provided.
Are you a guarantor or co-maker of any leases, contracts or debts?
Applicant Yes    No    Joint Applicant/Other Party Yes    No
Are there any suits or judgments pending against you?
Applicant Yes    No    Joint Applicant/Other Party Yes    No
Have you been declared bankrupt in the last 10 years?
Applicant Yes    No    Joint Applicant/Other Party Yes    No
 
PREVIOUS CREDIT REFERENCES
Describe any previous debt obligations. Please mark Applicant-related information with an "A".
1.
$     Date Paid
2.
$     Date Paid
 
NOT FOR FNMA/FHLMA/FHA/VA USE
 

By clicking the Submit button below, I/we certify that the information provided above is accurate to the best of my/our knowledge. I/We authorize Champion Bank to obtain a credit report. Must be of legal age.

        

 

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