Home Equity Loan Application

This is an application for INDIVIDUAL CREDIT.

This is an application for JOINT CREDIT. Please enter the initials of both applicants to indicate agreement of a joint credit application: Applicant 1:   Applicant 2:

 


Personal Information

Name
Phone
Social Security No.
Birthdate
Date
Address
City
State
Zip
Years There

 

Amount Requested

Employment Current employer
Phone
Years at this job


Co-Borrower

Name
Social Security No.
Birthdate

 

Employment Current employer
Phone
Years at this job


Income Information
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this loan.

Borrower's gross monthly income
Borrower's Other income
Borrower's Source
Co-borrower's gross monthly income
Co-borrower's other monthly income
Co-borrower's Source
Total of
Monthly Income(s)



Mortgage Information

Mortgage Company
Appraised value
Balance
Payment


Questions for borrower and co-borrower
(Check Yes or No for each question)

 

Borrower

CO-Borrower

Are there any outstanding judgment against you? Yes No Yes No
Have you declared bankruptcy? Yes No Yes No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years? Yes No Yes No
Are you a party in a law suit? Yes No Yes No
Are you obligated to pay child support, alimony or separate maintenance? Yes No Yes No
Are you a co-signer on any loan? Yes No Yes No
Are you a U.S. citizen? Yes No Yes No
If no, are you a resident alien? Yes No Yes No
If no, are you a non-resident alien? Yes No Yes No


Information for government monitoring purposes

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 and fair housing laws, you are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under federal regulations this lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish this information, please check the line below.


Borrower
I do not wish to supply this information.
Race/national origin:
American Indian/Alaskan native
Black Hispanic White
Sex
Male Female
CO-borrower
I do not wish to supply this information.
Race/national origin:
American Indian/Alaskan native
Black Hispanic White
Sex
Male Female


Agreement

By submitting this application, I (we) certify that everything I (we) have stated in this application is correct. You may keep this application whether or not it is approved. I (we) also authorize you to check my (our) credit and employment history and to answer questions others may ask you about my (our) credit record with you. I (we) understand that I (we) must update credit information at your request if my (our) financial condition changes. I (we) understand that the loan will be secured by a mortgage on the property described herein and represent that the property will not be used for any illegal or restricted purpose.

I (we) agree that additional information may be needed to process my (our) loan application and that submission of this online application does not constitute a full and complete application.

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.

The USA Patriot Act has paved the way for financial institutions to help prevent fraud, identity theft, and the spread of terrorism. It requires financial institutions to obtain more informations from an individual or legal entity to help establish identity.


Mid American Credit Union8404 West Kellogg DriveWichita, KS 67209316.722.3921Fax 316.722.0920