Home Equity Loan Application

Property Information

Funds will be used for*:

Borrower Information

Contact Information

Address History

Current Address

If residing at present address for less than 2 years, please complete the following:

Previous Address 1

Previous Address 2

Employment

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Previous Company 1

Previous Company 2

Current Monthly Income

* Self-employed Borrowers may be required to provide additional documentation such as tax returns and financial statements.

** Notice: 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.

Co-Borrower Information

Contact Information

Current Address

If residing at present address for less than 2 years, please complete the following:

Previous Address 1

Previous Address 2

Employment

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Previous Company 1

Previous Company 2

Current Monthly Income

* Self-employed Borrower or Co-Borrower may be required to provide additional documentation such as tax returns and financial statements.

** Notice: 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.

Housing Expenses

Expense Type Present Amount Proposed Amount
Rent
First Mortgage
Second Mortgage (P&I)
Hazard Insurance
Real Estate Taxes
Mortgage Insurance
Homeowner Association Dues
Other

Asset Information

This statement and any applicable supporting schedules may be completed jointly by both married and unmarried co-borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If the Co-borrower section was completed about a spouse, this Statement and supporting schedules must be completed about that spouse also.







Automobiles

Year Make Current Value
Auto 1
Auto 2
Auto 3

Liability Information

Liabilities and Pledged Assets. List the creditor’s name, address and account number for all outstanding debts including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.

Name of Creditor Monthly Payment Unpaid Balance Will this debt be paid off?

Other Payments

Alimony/Child Support/Separate maintenance Payments

Job related Expense (Childcare, union dues, etc.)

Schedule of Real Estate Owned

Property 1

 

Property 2

 

Property 3

 

Declarations

Borrower Answers

  1. Are there any outstanding judgments against you?
    Yes   No

    If yes, please explain below.

  2. Have you been declared bankrupt within the last 7 years?
    Yes   No

    If yes, please explain below.

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

    If yes, please explain below.

  4. Are you a party to a lawsuit?
    Yes   No

    If yes, please explain below.

  5. Have 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.
    Yes   No

    If yes, provide details in the space below including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.

  6. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
    Yes   No

    If yes, provide details in the space below including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.

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

    If yes, please explain below.

  8. Is any part of the down payment borrowed?
    Yes   No

    If yes, please explain below.

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

    If yes, please explain below.

  10. Are you a U.S. Citizen?
    Yes   No
  11. Are you a permanent resident alien?
    Yes   No
  12. Do you intend to occupy the property as your primary residence?
    Yes   No

    If yes, complete the questions below.

    Have you had an ownership interest in a property in the last three years?
    Yes   No

    What type of property did you own?

    How did you hold title to the home?

Co-Borrower Answers

  1. Are there any outstanding judgments against you?
    Yes   No

    If yes, please explain below.

  2. Have you been declared bankrupt within the last 7 years?
    Yes   No

    If yes, please explain below.

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

    If yes, please explain below.

  4. Are you a party to a lawsuit?
    Yes   No

    If yes, please explain below.

  5. Have 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.
    Yes   No

    If yes, provide details in the space below including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.

  6. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
    Yes   No

    If yes, provide details in the space below including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.

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

    If yes, please explain below.

  8. Is any part of the down payment borrowed?
    Yes   No

    If yes, please explain below.

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

    If yes, please explain below.

  10. Are you a U.S. Citizen?
    Yes   No
  11. Are you a permanent resident alien?
    Yes   No
  12. Do you intend to occupy the property as your primary residence?
    Yes   No

    If yes, complete the questions below.

    Have you had an ownership interest in a property in the last three years?
    Yes   No

    What type of property did you own?

    How did you hold title to the home?

List any additional names under which credit has previously been received and indicate appropriate creditor names and account numbers.

Alternate Name Creditor Name Account Number

Government Monitoring Information

The 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. You may select one or more designations for "race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.

Borrower

Sex

Co-Borrower

Sex

We authorize your company to check our credit, and verify any information stated on the loan application. We have read the fine print below. The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to dosing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property. Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.

By submitting this online application, I/We authorize AMERISTATE Bank to check such things as my/our credit, business and employment status and histories. I/We understand that more documentation may be required in order to complete the application process. Everything that I/we have stated in this application is correct to the best of my knowledge.

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Ameristate Bank has no control over information at any site hyperlinked to or from this website. Ameristate Bank makes no representation concerning and is not responsible for the quality, content, nature, or reliablity of any hyperlinked site and is providing this hyperlink to you only as a convenience. The Privacy and Security policies of the hyperlinked site may differ from those of Ameristate Bank. The inclusion of any hyperlink does not imply any endorsement, investigation, verification or monitoring by Ameristate Bank of any information in any hyperlinked site. In no event shall Ameristate Bank be responsible for your use of a hyperlinked site.

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Notice: Because there is a risk that information transmitted via Internet email could fall into the wrong hands, Ameristate Bank suggests that confidential information, such as account numbers or social security numbers, not be transmitted via email. Instead, please contact Ameristate Bank directly at your nearest bank branch.

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