| HOME EQUITY CREDIT APPLICATION |
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| Amount of Credit Requested: |
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Dollar Amount
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Maximum
I Qualify For |
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HOME
& MORTGAGE INFORMATION |
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| Type
of Property |
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Title
is held in what name(s) |
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Estimate
of current value: |
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| BORROWER INFORMATION |
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| Borrower |
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First
Name |
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Middle
Initial |
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Last
Name |
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Social
Security Number |
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Date
of Birth |
(mm/dd/yyyy) |
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Home
Phone |
(include area code) |
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Cell
Phone |
(include area code) |
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Marital Status:
Married
Unmarried (include single, divorced, widowed)
Separated |
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Current
Address |
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City |
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State |
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Zip |
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Own
Rent |
Number
of Years at Current Address
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E-Mail
Address |
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| Employment
and Income |
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Employment Status:
Employed
Self Employed
Retired
Unemployed
Other |
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Name
of Employer |
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Address
of Employer |
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City |
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State |
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Zip |
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Years
on this job |
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Business
Phone |
(include area code) |
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Title/Position |
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Employment
Income $
Before Taxes |
Annual
Monthly |
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Other
Income $
Before Taxes |
Annual
Monthly |
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Source
of Other Income |
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| Notice:
You do not have to disclose any alimony, child support, or separation
maintenance income unless you choose to have it considered as a basis
for repaying this loan. |
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| Co-Borrower |
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First
Name |
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Middle
Initial |
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Last
Name |
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Social
Security Number |
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Date
of Birth |
(mm/dd/yyyy) |
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Home
Phone |
(include area code) |
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Cell
Phone |
(include area code) |
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Marital Status:
Married
Unmarried (include single, divorced, widowed)
Separated |
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Relationship
to Borrower
Spouse
Parent
Child
Friend
Other
None |
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Co-Borrower's
Primary Residence |
Same as borrower (proceed to employment & income section) |
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Different from borrower, complete address information |
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Current
Address |
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City |
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State |
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Zip |
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Own
Rent |
Number
of Years at Current Address
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E-Mail
Address |
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| Employment and Income |
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Employment Status:
Employed
Self Employed
Retired
Unemployed
Other |
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Name
of Employer |
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Address
of Employer |
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City |
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State |
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Zip |
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Years
on this job |
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Business
Phone |
(include area code) |
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Title/Position |
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Employment
Income $
Before Taxes |
Annual
Monthly |
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Other
Income $
Before Taxes |
Annual
Monthly |
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Source
of Other Income |
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| Notice:
You do not have to disclose any alimony, child support, or separation
maintenance income unless you choose to have it considered as a basis
for repaying this loan. |
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| Liabilities: |
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Your
Mortgage Balance: |
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Any
current Home Equity Credit balance: |
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Total
Liabilities: |
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| ACKNOWLEDGMENT AND AGREEMENT |
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By
selecting the “Submit Application” button below, I/We certify
and acknowledge the following
1. I/We
have read all applicable credit disclosures;
2. I/We applies for the loan indicated in this application to be secured
by a mortgage on deed of trust on the property describe herein, and
represents that the property will not be used for any illegal or restricted
purpose;
3. I/We represent that all statements made on this application are
true and made for the purpose of obtaining the loan;
4. The Lender may obtain verification from any source named in this
application, the original or a copy of this application will be retained
by the Lender, even if the loan is not granted;
5. I/We authorize the Lender to make any necessary credit investigation
and answer questions about the Bank’s credit experience with
me/us;
6. I/We understand that the Lender may request additional information
including personal financial information from me during the application
process.
7. I/We fully understand that it is a federal crime punishable by
fine or 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, Section 1014.
Finally,
I/we agree that the act of clicking the “Submit Application”
button below will constitute your legally binding signature(s), and
Community Bank Wheaton/Glen Ellyn will be entitled to rely on it as
such for all purposes.
[Link
to “When your Home is on the Line”]
[Link
to “Variable Rate Home Equity Early Disclosure”] or [Link
to “Flex Rate Home Equity Early Disclosure”]
Yes, I/we certify and acknowledge that I/we have read the above information,
the product terms and conditions, and all applicable legal disclosure
information.
Right to Receive Copy of Appraisal
I/We
have the right to a copy of the appraisal report used in connection
with this application for credit. To obtain a copy, I/we must send
Lender a written request at the mailing address Lender has provided.
Lender must hear form me/us no later than 90 days after Lender notifies
me/us about the action taken on this application, or I/we withdraw
this application.
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| To apply, print this completed application and fax, mail or bring it to any of our locations. |