CONSUMER CREDIT APPLICATION

Amount of Credit Requested □ $ CONSUMER CREDIT APPLICATION Type of Loan: □ Residential Mortgage Purchase/ Refi (please circle) □ □ Home Equity Loan □ BORROWER INFORMATION Date of Birth Cell Phone (include area code) Social Security Home Phone (include area code) Auto Loan Home Equity Line of Credit □ Maximum I Qualify For Borrower Borrower’s Name (include Jr. or Sr. if applicable) Social Security Number Home Phone (include area code) □ Personal Line/Loan Co-Borrower Date of Birth Cell Phone (include area code) Co-Borrower’s Name (include Jr. or Sr. if applicable) Complete ONLY if loan will be secured by property or real estate. Complete ONLY if loan will be secured by property or real estate. □ Married □ Unmarried (include single, divorced, widowed) □ Separated Current Address (street, city, state, zip code) □ Own □ Rent No. Yrs Name & Address if Employer Years on the job Annual Income $ Business Phone (include area code) □ Married □ Unmarried (include single, divorced, widowed) □ Separated Current Address (street, city, state, zip code) □ Own □ Rent No. Yrs Name & Address if Employer Years on the job Annual Income $ Business Phone (include area code) □ Self Employed Title/Position/Type of Business □ Self Employed Title/Position/Type of Business If you were employed in your current position for less than two years, or if you have income from other sources which you would like to have considered for paying this loan, please attach a separate statement. Notice: You do not have to disclose any alimony, child support, or separation maintenance income unless you choose to have it considered as a basis for repaying this loan. ABOUT YOUR HOME Type of Property □ Single Family Residence Your Mortgage Balance: $ Insurance Company □ Condominium/Townhome □ Other (2,3, or 4 Flat) Any current Home Equity Credit Balance: $ Agent Name & Number: Estimated Value: $ Tell us about Your Assets Please indicate if Applicant(A) Or Co-Applicant(Co-A) By Checking Appropriate Box In Left Columns. Tell us about Your Liabilities Please indicate if Applicant(A) Or Co-Applicant(Co-A) By Checking Appropriate Box In Left Columns. A Co-A Name of Bank, S&L, or Credit Union: A $ $ $ Co -A Mortgage-Holder/Landlord: MUST BE COMPLETED □ □ □ □ □ □ □ Stocks & Bonds: □ □ Mortgage-Holder/Landlord (Subject Property) Mortgage-Holder/Landlord Mo.s pmt. $________ Upd. Bal $________ □ □ □ □ □ □ □ □ □ Creditor Tx. Ins. Dues $______ $________ $__________ Mo.s pmt. Upd. Bal $________ $________ Tx. Ins. $ Ins. $ Upd. Bal. $ Upd. Bal. $ Upd. Bal. $ Upd. Bal. $ Dues $ Mos. Left $ Mos. Left $ Mos. Left $ Mos. Left $ Accounts Payable: □ Real Estate Owned: $ Mo.s Pmt. $ Mo.s Pmt. $ Mo.s Pmt. $ Mo.s Pmt. $ Creditor Creditor □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ Property Address $ Property Address $ □ □ □ Creditor Alimony/Child Support/Separate Maintenance Owed To: Property Address $ Name Mo.s pmt. Total Liabilities: Property Address $ $ Vested Interest in Retirement Fund: $ (Please attach a separate sheet of paper if more space is needed.) 1938 E. Lincoln Highway New Lenox, IL 60451 815-463-7002 Fax: 815-463-1370 515 N. LaGrange Road Frankfort, IL 60823 815-806-7001 Fax: 815-806-0572 Net Worth of Business(es) Owned: □ □ □ (Attach Financial Statement) $ Automobiles Owned (Make & Model) $ $ Other Assets (Itemize): □ □ $ $ $ ACKNOWLEDGMENT and AGREEMENT Total Assets I/We hereby apply for the loan or credit described in this application. I/We certify that I/we made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose. Lender may disclose to any other interested parties information as to Lender’s experiences or transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I/We further authorize Lender to provide to any such insurer of investor any information and documentation that they may request with respect to my/our application, credit or loan. APPLICANT: X Applicant Date X Co-Applicant Date Borrowers' Certification and Authorization Below is a list of documents that Town CenterBank will needto processyour loan request: l. Completedapplicationand signedBorrowers' Certificationand Authonzation. 2. Copy of your last 2 yearsof personaltax returns. If self-employed, copy of your last a returns. two yearsbusinessta>( 3. Copyof last2 yearsW-2's. 4. Copy of I month of pay stubs. 5. Copy of your curent homeowner's insurance showingthe agentsnameand phone number. 6. Copy of your current mortgage statement. 7. Copy of your current2nd mortgagestatement, applicable. if To Whom It May Concern: l. IAVe have appliedfor a loan throughTown CenterBank. As a part of the application process,Town Center Bank may verifr information containedin my/our loan application and in other documents with the loan, eitherbeforethe loan is requiredin connection closedor as part of its quality confol program. 2. UWe authorizeyoUto provide to Town CenterBank and to any investorto whom Town CenterBank may sell my loan, any and all informationand documentation that they request. Suchinformation includes,but is not limited to, employmenthistory and income;bank, money marketand similar accountbalances; credit history and reports;and copiesof incometa:( returns. 3. Town CenterBank or any investorthat participates the loan may address in this authorization any party namedin the loan application. to 4. A copy of this authorizationmay be accepted an original. as Borrower Signature DATE Co-BorrowerSignature SSN: SSN: DATE