unsecured loan

GreenStreet Unsecured Consumer Loan In an effort to give you the best possible service, we are requesting that you provide us with the following information. By doing so, we will be able to process your request in a timely manner. Two current paycheck stubs for each employed applicant. If Self Employed: Two years tax returns including all supporting schedules. If you are involved in a corporation or partnership, include K-1s from your business tax returns. Bid or proposal from an Energy Trust affiliated Trade Ally including the utility company or companies involved in this project. Included in this packet for your completion are: Consumer Loan Application Government Monitoring Form (required for all home improvement loans) Once your application packet is complete, submit it to us using the following options: 1. Drop it off at an Umpqua Store near you. 2. Fax it to our Retail Lending Center at 1-541-378-9210. 3. Mail it to: Umpqua Bank Mail Code 560-B-CLC PO Box 1820 Roseburg, OR 97470 - or Call our Customer Contact Center at 1-866-790-2121 and apply by phone. Revised 12.01.08 Application # __________________ Store # _____________ Received By: _______________________ Date Received: ______________ CONSUMER CREDIT APPLICATION UMPQUA EXPRESSLINE CREDIT LIMIT REQUESTED $ OR ■ INCREASE EXISTING LIMIT ________________ ■ AUTOMATIC PAYMENT _______________________ PAYMENT DUE DATE: Member FDIC ■ OVERDRAFT PROTECTION CHECKING ACCOUNT # IMPORTANT: Read these directions before completing this application. Please complete in pen (blue or black ink only). Check Appropriate Box: and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Section A and C. — OR — OTHER LOAN OR LINE REQUEST: ■ UNSECURED $__________________ AMOUNT REQUESTED ■ SECURED ____________________________ LOAN TYPE ■ If you are applying for an individual account in your own name _________ TERM ____________________________ SECURED BY DESIRED PAYMENT DATE PURPOSE OF LOAN ■ If you are applying for a joint account or an account that you and another person will use, complete all sections, providing information in Section B about the joint applicant or user. SECTION A / APPLICANT INFORMATION Full Name (First M.I. Last) Previous Physical Address Home Phone Number How Long ____Yr ____ Mo Do you wish to have your payments automatically deducted from your account? ■ Yes ■ No Account Number _______________________________ (Do not complete this section if this is an application for individual unsecured credit in your own name.) Marital Status: ■ Married ■ Unmarried ■ Separated How Long _____Yr _____Mo Home Address (Street, City, State, Zip Code) Mailing Address (if different from Home Address) Date of Birth Relationship ■ Own ■ Rent ■ Space Rent ■ Live w/Parents PMT $_________ Ages of Dependents Phone Number ( ) Social Security Number Name/Address of nearest relative NOT living with you. Employer (If Self-Employed, Name/Nature of Business, 2 Yr. Tax Returns Required) ( ) Occupation _____Yr _____Mo Current Business Phone ( ) Current Mo. Salary/Gross Former Employer - Complete if less than two years current employment _____Yr _____Mo OTHER INCOME: 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 obligation. Source Amount $ Have you ever: declared bankruptcy? had merchandise repossessed? Marital Status: ■ Yes ■ No ■ Yes ■ No How Long SECTION B / CO-APPLICANT INFORMATION Full Name (First M.I. Last) Previous Physical Address Home Phone Number How Long ____Yr ____ Mo ■ Married ■ Unmarried ■ Separated _____Yr _____Mo Home Address (Street, City, State, Zip Code) Mailing Address (if different from Home Address) Date of Birth Relationship ( ) Social Security Number Ages of Dependents Phone Number ■ Own ■ Rent ■ Space Rent ■ Live w/Parents PMT $_________ Name/Address of nearest relative NOT living with you. Employer (If Self-Employed, Name/Nature of Business, 2 Yr. Tax Returns Required) ( ) Occupation _____Yr _____Mo Current Business Phone ( ) Current Mo. Salary/Gross Former Employer - Complete if less than two years current employment _____Yr _____Mo OTHER INCOME: 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 obligation. Source Amount $ Have you ever: declared bankruptcy? had merchandise repossessed? ■ Yes ■ No ■ Yes ■ No FOR INTERNAL USE ONLY Applicant Identification Co-applicant Identification ID #1. _____________________________________ Exp._____________ ID #1. _____________________________________ Exp._____________ ID #2. _____________________________________ Exp._____________ ID #2. _____________________________________ Exp._____________ UB-202 11/08 1 of 3 SECTION C / FINANCIAL PROFILE ✓ Check if assets held jointly. ✓ ASSETS Checking Accounts/Institution CURRENT VALUE DEBT OUTSTANDING Credit Cards (List by Name) BALANCE MONTHLY PAYMENT DO YOU WANT THIS ACCOUNT PAID OFF? Savings Accounts/Institution Automobile Year Make Auto Loans Is your home a manufactured home? Current Market Value of Real Estate Other Real Estate Value ■ Yes ■ No Name of Mortgage Lender ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Other Real Estate Loans Yes Yes Yes Yes Yes Yes Yes Yes Yes Boat/Recreational Vehicle Other Debts IRA, Retirement, Profit Sharing Market Value of Stocks/Bonds Alimony/Child Support TOTAL ASSETS (A) TOTAL DEBT (B) NET WORTH (A minus B) Applicant’s (and Co-Applicant’s) Statement PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING. By signing below, I am asking Umpqua Bank to approve my application for an UMPQUA EXPRESSLINE account or installment loan. I/We certify that the statements on the application are true, complete, and correct. I/we agree that inquiries may be made to verify information and that credit references or verification may be given based on inquiries from other parties, including other financial institutions from which you have requested credit. Lender may keep this application even if it decides not to make the loan to me/us. This offer is subject to the credit policies of Umpqua Bank. For UMPQUA EXPRESSLINE – By signing below, I/we also acknowledge that I/we have received and read the UMPQUA EXPRESSLINE Personal Revolving Credit Agreement provided with this application and I/we agree to be bound by the terms and conditions stated in that Agreement, and I/we agree to be bound by the terms stated in the enclosed UMPQUA EXPRESSLINE – Personal Application Addendum for additional services, if any, I/we requested on that Addendum, if my request for an UMPQUA EXPRESSLINE – Personal Revolving Line of Credit is approved by Umpqua Bank. If this is a joint application, the undersigned shall be jointly and severally liable for any and all credit extended from time to time under the UMPQUA EXPRESSLINE account and/or installment loan to which this application applies. X ___________________________________ Applicant ________ Date X ___________________________________ Co-Applicant ________ Date CREDIT INSURANCE Applicant desires additional information on voluntary insurance: Co-Applicant desires additional information on voluntary insurance: ■ ■ Credit Life Credit Life ■ Credit Disability ■ ■ I do not desire Credit Insurance I do not desire Credit Insurance ■ ■ Not Eligible Not Eligible CONSUMER CREDIT DISCLOSURE To Credit Applicant: Umpqua Bank may not condition the extension of credit on the following: • Your purchase of insurance from Umpqua Bank or any of its affiliates. • Your Agreement to not obtain insurance from an entity not affiliated with Umpqua Bank. In addition, Umpqua Bank may not prohibit you from obtaining insurance from an entity not affiliated with Umpqua Bank. Insurance: The insurance product you are buying: • Is not insured by the Federal Deposit Insurance Corporation (FDIC) or any other agency of the United States, Umpqua Bank or any affiliate of Umpqua Bank. • Is not a deposit or obligation of Umpqua Bank or any of its affiliates. • Is not guaranteed by Umpqua Bank or any of its affiliates. Please acknowledge written and verbal receipt of this disclosure by signing below. You should retain the attached copy for your records. X ___________________________________ Applicant ________ Date X ___________________________________ Co-Applicant ________ Date UB-202 11/08 2 of 3 CONSUMER CREDIT DISCLOSURE This document is a written disclosure for the sale of insurance when Umpqua Bank extends credit. To Credit Applicant: Umpqua Bank may not condition the extension of credit on the following: Your purchase of insurance from Umpqua Bank or any of its affiliates. Your Agreement to not obtain insurance from an entity not affiliated with Umpqua Bank. In addition, Umpqua Bank may not prohibit you from obtaining insurance from an entity not affiliated with Umpqua Bank. Insurance: The insurance product you are buying: Is not insured by the Federal Deposit Insurance Corporation (FDIC) or any other agency of the United States, Umpqua Bank or any affiliate of Umpqua Bank. Is not a deposit or obligation of Umpqua Bank or any of its affiliates. Is not guaranteed by Umpqua Bank or any of its affiliates. IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW LOAN 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 up an account, we will ask for your name, address, date of birth, and other information that allows us to identify you. We may also ask to see your driver’s license or other identifying documents. CUSTOMER COPY UB-202 11/08 3 of 3 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, 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. APPLICANT: I do not wish to furnish this information Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Sex: Female Male CO-APPLICANT: I do not wish to furnish this information Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Sex: Female Male To Be Completed by the Interviewer: Face-to-Face Interview Application Received By Mail Application Received By Telephone Interviewer’s Name: (Print or type): Interviewer’s Signature: Interviewer’s Phone Number (incl. area code): Name and Address of Interviewer’s Employer: Umpqua Bank PO Box 1820 Roseburg, OR 97470