HELOC Application Form

HomeHELOC Application Form

Home Equity Line of Credit Application

Important Information About Procedures For Opening a New Account

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents and use third party identifiers such as chex systems and/or credit bureau reports.

* - Indicates required fields

HELOC Information

Is there a First Security Bank lender assisting you with this application? *

Are you applying for joint credit? If yes is checked, this is an Application for Joint Credit. By signing below, the Applicant and Co-Applicant agree that each of us intend to apply for joint credit. (Complete Applicant and Co-Applicant sections.) * Yes No

Total Loan Amount *

Borrower Information

First Name *

Middle Initial

Last Name *

Suffix

Social Security Number *

Birth Date *

Primary Phone Number *

E-mail Address *

Housing

Home Address *

City *

State *

Zip Code *

Mailing address is different than street address.

Mailing Address *

City *

State *

Zip Code *

Residency Start Date

Monthly Mortgage Payment

Have you lived here for two or more years? * Yes No

Previous Home Address *

City *

State *

Zip Code *

Residency Start Date *

Monthly Mortgage Payment *

Marital Status * Married Unmarried (single, divorced, widowed) Separated

Number of Dependents (Not Listed by Co-Borrower)

List Dependents' Ages

Employment Information

Is the borrower employed? * Employed Not Employed

Employment Start Date *

Position or Title *

Gross Monthly Income *

Name of Employer *

Employer's Address *

City *

State *

Zip Code *

Employer's Phone Number *

Have you worked here for more than two years? * Yes No

Previous Employer

Employment Start Date

Position or Title

Gross Monthly Income

Name of Employer

Employer's Address

City

State

Zip Code

Employer's Phone Number

Co-Borrower Information

First Name *

Middle Initial

Last Name *

Suffix

Social Security Number *

Birth Date *

Primary Phone Number *

E-mail Address *

Housing

Home Address *

City *

State *

Zip Code *

Mailing address is different than street address.

Mailing Address *

City *

State *

Zip Code *

Residency Start Date

Monthly Mortgage Payment

Have you lived here for two or more years? * Yes No

Previous Home Address *

City *

State *

Zip Code *

Residency Start Date *

Monthly Mortgage Payment *

Marital Status * Married Unmarried (single, divorced, widowed) Separated

Number of Dependents (Not Listed by Borrower)

List Dependents' Ages

Employment Information

Is the co-borrower employed? * Employed Not Employed

Employment Start Date *

Position or Title *

Gross Monthly Income *

Name of Employer *

Employer's Address *

City *

State *

Zip Code *

Employer's Phone Number *

Have you worked here for more than two years? * Yes No

Previous Employer

Employment Start Date

Position or Title

Gross Monthly Income

Name of Employer

Employer's Address

City

State

Zip Code

Employer's Phone Number

Financial Information

Please note: Alimony, child support or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan. Also self employed borrowers may be required to provide additional documentation such as tax returns and financial statements. (before taxes)

Borrower's Gross Monthly Income

Monthly Salary & Wages *

Other Monthly Income (if any)

Income Type *

Co-Borrower's Gross Monthly Income

Monthly Salary & Wages *

Other Monthly Income (if any)

Income Type *

Current Monthly Housing Expenses

First Mortgage

Second Mortgage

Hazard Insurance

Property Taxes

Mortgage Insurance

Home Owners Association Dues

Real Estate

Second Home/Investment Property

Property Address

City

State

Zip Code

Estimated Value

Declarations

Borrower

Are there any outstanding judgments against you? * Yes No

Explain *

Have you been declared bankrupt within the past 7 years? * Yes No

Explain *

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? * Yes No

Explain *

Are you a party to a lawsuit? * Yes No

Explain *

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or 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

Explain *

Are 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

Explain *

Are you obligated to pay alimony, child support, or separate maintenance? * Yes No

Explain *

Is any part of the down payment borrowed? * Yes No

Explain *

Are you a co-maker or endorser on a note? * Yes No

Explain *

Are you a U.S. citizen? * Yes No

Are you a permanent resident alien? * Yes No

Explain *

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

Type of Property Owned

How the Property Was Held

Co-Borrower

Are there any outstanding judgments against you? * Yes No

Explain *

Have you been declared bankrupt within the past 7 years? * Yes No

Explain *

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? * Yes No

Explain *

Are you a party to a lawsuit? * Yes No

Explain *

Are you obligated to pay alimony, child support, or separate maintenance? * Yes No

Explain *

Is any part of the down payment borrowed? * Yes No

Explain *

Are you a co-maker or endorser on a note? * Yes No

Explain *

Are you a U.S. citizen? * Yes No

Are you a permanent resident alien? * Yes No

Explain *

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

Type of Property Owned

How the Property Was Held

Acknowledgement & Agreement

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its services, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer credit reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

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 1001, et seq.

Type your name in the box below to represent your electronic signature.

Chris Ryan NMLSR #784944

First Security Bank NMLSR #758359

To find a Housing Counselor, please visit the Consumer Financial Protection Bureau to locate the counselors nearest you.

Please check here that you have visited the Consumer Financial Protection Bureau website. (You must read the document to enable this checkbox.) *

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Appraisal Notification - We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close. you can pay for an additional appraisal for your own use at your own cost.

Borrower's Signature *

Date

Co-Borrower's Signature *

Date