LPS Employees Federal Credit Union

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					                               LPS Employees Federal Credit Union
                 5625 O Street, Suite 106, Lincoln, NE 68510 Ph. 402-486-3644 Fax 402-486-3646                              Revised 12/2011

                                      Home Equity Loan Application                           (Complete form, Print, Sign and bring or mail to us)   n
I/We are applying for:      □ Individual Credit or □ Joint Credit                 Refinance of existing loan? Yes / No
Amt Requested: $__________________                   Loan Term: _________ (months or years)
Purpose of loan: □ Home Improvement □ Refinance existing home loan □ Payoff other debt □ Other
Method of loan payment: □ LPS Payroll (Optional) □ Loan Coupons □ Bank Transfer □ Savings Trf

Name of Member / Applicant ___________________________________________________ Acct # ________________

Mailing address:______________________________________ City_________________ State_____ Zip____________

Address of property to be used as security for this loan:   □ Same / Other    ______________________________________

Home Phone or Cell #______________________ Work Ph # __________________ Email ________________________

LPS Position/Location_________________________________________ Sup’v _________________ Yrs w/ LPS ______

Monthly income or Annual Salary $___________________ Other income $__________________ (if you wish to disclose)
                                                                 (You are not required to disclose Alimony or Child Support payments)
Reference: (Nearest relative not living with you) __________________________________________________________
For Joint Credit:          Applicant ______          Co-Applicant _____         Applicant & Co-Applicant must initial approval

Name of Spouse or individual who will be equally liable:____________________________________________________

Address: (If different) _________________________________________ City______________ State_____ Zip________

Employer/Position _____________________________________________ Sup’v ________________ Yrs Emp _______

Soc Sec #____________________ Birth date _______________ Monthly Income or Annual Salary _________________
                                                                 (You are not required to disclose Alimony or Child Support payments)

Current tax assessed or appraised value of home:                                         $ ___________________
Total amount of mortgage and/or other home equity loans on this property:                $ ___________________

Name of insurance company / agent for this property?        __________________________________________

                                                                                         Applicant            Co-Applicant
Will the new loan money be used to payoff or reduce other current debts?                 Yes / No             Yes / No
           If so, provide the accounts to be paid on the back of this application.
Is your income likely to be reduced before this loan is paid off?                        Yes / No             Yes / No
           If yes, explain on the back side of this application.
To the best of your knowledge are there any liens, judgements or foreclosures            Yes / No             Yes / No
          on this property? If so, provide details on the back of this application.
Are any credit accounts currently past due or in collection?                             Yes / No             Yes / No
          If yes, please provide details on the back of this application.
Have you co-signed a loan for someone other than your spouse?                            Yes / No             Yes / No
         If yes, provide loan details on the back of this application.

Everything stated in this application is correct to the best of my knowledge, and I authorize the Credit Union
to verify my employment history and to obtain information about my credit history.

Signature of Applicant __________________________________________________ Date___________________

Signature of Joint Applicant _____________________________________________ Date___________________
Additional Details or Loan Information.

Government Monitoring Information. Required for Home Mortgage Disclosure Act.

Ethnicity -     □ White     □ Black        □ Asian              □   Hispanic   □   Other
Age of Applicant ______ Age of Co-Applicant _____
Sex of Applicant ______     Sex of Co-Applicant _____
Marital Status   □   Married     □   Single     □   Divorced    □   Widowed

For Credit Union Staff:
Member # ____________      New Loan / Refinance     CU Board member, CU Committee or CU Employee Yes / No

Total Mo Debt $____________ Mo Income $____________ Debt Ratio ______% to Net / Gross % Unsecured Debt _____ %

Total New Loan $________________ Interest rate ________%       Term / months ________ Payments of $___________

Credit Report Date _______________ Credit Score: CU _________ FICO__________ Loan to Value _____________
Loan Code – M - Home Equity - Purpose /Collateral - Hm Equity - D / 80   1 Mortgage – O / 85

Payment – LPS Payroll: 40 / All Other: 00 Payment by: CU Transfer / Loan Coupons / ACH     Req Payment $ ________

Loan Note # __________ Sfx: _____      Loan date: ___________________ First payment date: ____________________

The loan has been approved as submitted. Yes / No

Loan Officer ________________________________ Date ______________________

□ The loan is being denied as submitted.
         Reason(s) for denial: ________________________________________________________________________

□ The following counter offer will be made to the applicant and if accepted, the loan is approved.
         Describe: _________________________________________________________________________________

□ Credit Committee reviewed and signed approval / denial of above action on this date: ______________________
□ Fed’l Equal Op Act Notice completed and mailed or delivered on ________________________________________
Loan to Credit Union Staff or Official requiring Board approval. (4 signatures required)

     1. _____________________________________________________________

     2. _____________________________________________________________

     3. _____________________________________________________________

     4. _____________________________________________________________

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