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Western State Bank

Home Equity Loan Application

Application is for
Type of Loan

Primary Applicant Information

Current Address

Ownership

Prior Address (If less than 2 years at current address)

Current Employer

* Alimony, child support or separated maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying the obligation

Co-Applicant/Guarantor Information

Current Address

Ownership

Prior Address (If less than 2 years at current address)

Current Employer

* Alimony, child support or separated maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying the obligation

Personal References

Customer Identification Information

Important Information for Opening A New Account

To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means to you: When you open an account, we will ask for your name, physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.

Financial Information

Checking Account

Savings Account

Home Owners Insurance


Are there any outstanding judgments against you?
Do you have any open accounts that have been turned over to a collection agency?
Have you declared bankruptcy within the past 7 years?
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Are you party to a lawsuit?
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?
Are you presently delinquent or in default of any federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee?
Are you obligated to pay child support, alimony, or separate maintenance?
Are you a co-maker or endorser on a note?
Are you a U.S citizen?

My Assets (What I Own)

 

My Obligations (What I Owe)

 

Signatures

I (We) certify that everything I have stated in this Application and on any attachments is correct. You may keep this Application whether or not it is approved. By signing below, I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record . I understand that I must update credit information at your request or if my financial condition changes.

Applicant's Marital Status **
Co-Applicant's Marital Status **

**Do not provide this information if your application is for individual, unsecured credit, unless you reside in a community property state or will be relying on property located in such a state for repayment of the credit requested.

Complete the Section Below ONLY if the Application is for a Term Loan for one of the following:

  1. Home Purchase Loan
  2. Home Improvement Loan Secured by a Dwelling
  3. Refinance of a Dwelling, Secured by a Dwelling

Information For Government Monitoring Purposes

THE PURPOSE OF COLLECTING THIS INFORMATION IS TO HELP ENSURE THAT ALL APPLICANTS ARE TREATED FAIRLY AND THAT THE HOUSING NEEDS OF COMMUNITIES AND NEIGHBORHOODS ARE BEING FULFILLED. FOR RESIDENTIAL MORTGAGE LENDING, FEDERAL LAW REQUIRES THAT WE ASK APPLICANTS FOR THEIR DEMOGRAPHIC INFORMATION (ETHNICITY, SEX AND RACE) IN ORDER TO MONITOR OUR COMPLIANCE WITH EQUAL CREDIT OPPORTUNITY, FAIR HOUSING, AND HOME MORTGAGE DISCLOSURE LAWS. YOU ARE NOT REQUIRED TO PROVIDE INFORMATION, BUT ARE ENCOURAGED TO DO SO. THE LAW PROVIDES THAT WE MAY NOT DISCRIMINATE ON THE BASIS OF THIS INFORMATION, OR ON WHETHER YOU CHOOSE TO PROVIDE IT. HOWEVER, IF YOU CHOOSE NOT TO PROVIDE THE INFORMATION AND YOU HAVE MADE THIS APPLICATION IN PERSON, FEDERAL REGULATIONS REQUIRE US TO NOTE YOUR ETHNICITY, SEX, AND RACE ON THE BASIS OF VISUAL OBSERVATION OR SURNAME. THE LAW ALSO PROVIDES THAT WE MAY NOT DISCRIMINATE ON THE BASIS OF AGE OR MARITAL STATUS INFORMATION YOU PROVIDE IN THIS APPLICATION.
INSTRUCTIONS: YOU MAY SELECT ONE OR MORE “HISPANIC OR LATINO” ORIGINS AND ONE OR MORE DESIGNATIONS FOR “RACE.” IF YOU DO NOT WISH TO PROVIDE SOME OR ALL OF THIS INFORMATION, SELECT THE APPLICABLE CHECK BOX.

Applicant

Ethnicity

Sex

Race

Co-Applicant

Ethnicity

Sex

Race

Form Version 4/26/18

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