Home Equity/Line of Credit Application APPLICATION Step 1 of 5 - Request Information 20% Completion Instructions Complete the Applicant Information section for the first Applicant. If the Applicant is married, he or she may apply for individual credit. If applying for a Joint credit, the Co-Applicant MUST complete his or her own separate form. Both the Applicant and the Co-Applicant should indicate the name of the person they're applying with in the Comments / Special Instructions section of this form.Loan InformationLoan Type* Home Equity Loan Home Equity Line of Credit I would like more information on both Amount Requested*Property Type* Single Family Home 2 - 4 Family Home Condominium / Townhouse Purpose of Loan* Term in Months* Applicant/IncomeApplication type* Individual Joint Primary applicant InformationHow did you hear about us? (select all that apply)* Credit Union Promotion / Contest My Employer Referred By An Existing Member Facebook Instagram Twitter YouTube Google Search Financial Education Class Community Event 93.7 WBLK WIVB or WNLO TV Commercial I'm An Existing Member/Borrower Family / Friend / Co-Worker Referral Name* First Last Social Security Number* Date of Birth* MM slash DD slash YYYY Home Phone Number*E-mail Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Income InformationCurrent Employer* If self employed, name and nature of business. If you are retired, please simply enter "retired" in this field.Income*Per* Hour Week Month Year Pay type* Gross Take home Number of hours worked per week*Other income Source Per Hour Week Month Year Co-Applicant InformationName* First Last Social Security Number* Date of Birth* MM slash DD slash YYYY Home Phone Number*E-mail Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Co-Applicant Income InformationCurrent Employer* If self employed, name and nature of business. If you are retired, please simply enter "retired" in this field.Income*Per Hour Week Month Year Pay type Gross Take home Number of hours worked per weekOther income Source Per Hour Week Month Year Assets/Liabilities/HMDAAssetsBank/AssetAsset TypeAsset ValueAsset TypeAsset Value LiabilitiesCreditorCreditorOutstanding BalanceMonthly Payment Comments / Special InstructionsList comments or special instructions in the area provided below. If you are applying for Joint credit, please type the name of the person you are applying with on box below.Comments / Special InstructionsHDMA QuestionsThe 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. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not with to furnish this information, please check the box below.Opt out of HDMA Questions I do not wish to furnish this information Ethnicity Hispanic or Latino Not hispanic or Latino Race American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White or Caucasian Gender Male Female HDMA Co-applicant QuestionsThe 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. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not with to furnish this information, please check the box below.Opt out of HDMA Questions I do not wish to furnish this information Ethnicity Hispanic or Latino Not hispanic or Latino Race American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White or Caucasian Gender Male Female DeclarationsIf you answer "yes" to any of the following questions, please explain.ApplicantAre there any outstanding judgments against you? Yes No EplainHave you been declared bankrupt within the past 7 years? Yes No EplainHave you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? Yes No EplainAre you party to a lawsuit? Yes No EplainHave you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If “Yes,” provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.) Yes No EplainAre you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee? If “Yes,” give details as described in the preceding question. Yes No EplainAre you obligated to pay alimony, child support, or separate maintenance? Yes No EplainIs any part of the down payment borrowed? Yes No EplainAre you a co-maker or endorser on a note? Yes No EplainAre you a US citizen? Yes No Are you a permanent resident alien? Yes No Do you intend to occupy the property as your primary residence? Yes No Have you had an ownership interest in a property in the last three years? Yes No What type of property did you own? Principal residence (PR) Second home (SH) Investment property (IP) How did you hold title to the home? Jointly with your spouse (SP) Solely by yourself (S) Jointly with another person (O) Co-ApplicantAre there any outstanding judgments against you? Yes No EplainHave you been declared bankrupt within the past 7 years? Yes No EplainHave you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? Yes No EplainAre you party to a lawsuit? Yes No EplainHave you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If “Yes,” provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.) Yes No EplainAre you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee? If “Yes,” give details as described in the preceding question. Yes No EplainAre you obligated to pay alimony, child support, or separate maintenance? Yes No EplainIs any part of the down payment borrowed? Yes No EplainAre you a co-maker or endorser on a note? Yes No EplainAre you a US citizen? Yes No Are you a permanent resident alien? Yes No Do you intend to occupy the property as your primary residence? Yes No Have you had an ownership interest in a property in the last three years? Yes No What type of property did you own? Principal residence (PR) Second home (SH) Investment property (IP) How did you hold title to the home? Solely by yourself (S) Jointly with your spouse (SP) Jointly with another person (O) Agreement of TermsThe applicant whose name appear on this application certifies that the information submitted herein is true and complete. The applicant authorizes the Credit Union to obtain information as it may require concerning the statements made in this application including credit reports and employment history and to provide information to others about Credit Union's credit experience with the applicant. The Credit Union may retain this application whether or not it is approved. Good Neighbors FCU MLS ID #662517 Brian Stumm MLS ID #699267 Justin Jageman MLO #2580257 Do you agree to the above terms?* I Agree PhoneThis field is for validation purposes and should be left unchanged.
