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HOME EQUITY CREDIT APPLICATION
IMPORTANT: Read these directions before completing the Application and check the
appropriate box below.
If you are applying for individual credit in your own name and are relying on your income or assets and not the income or assets of another
person as the basis for repayment of the credit requested, complete Sections A, C, D and E, omitting B and the second part of C.
If this is an application for joint credit with another person, complete all Sections, providing information in B about the
joint applicant. If you intend to apply for joint credit please initial here: Applicant ____________ Co-Applicant ___________
If you are applying for individual credit, but are relying on income from alimony, child support or separate maintenance or on the income or
assets of another person as the basis for repayment of the credit requested, complete all Sections to the extent possible, providing information
in section B about the person on whose alimony, support, or maintenance payments or income or assets you are relying on.
_________________________________________________________________________________________
AMOUNT REQUESTED: $________________________________TERM OF LOAN: ________________
PURPOSE: ______________________________________________________________________________
_________________________________________________________________________________________
SWSB ACCOUNT USED FOR AUTOMATIC DEBIT: _________________________________________
_________________________________________________________________________________________
SECTION A - INFORMATION REGARDING APPLICANT
Full Name (Last, First, Middle) _______________________________________________________________
Present Street Address: ____________________________________________________Years there: ________
City: ________________________State:___________Zip:________________Telephone:_________________
Social Security No: ____________________Drivers License No: _________________ Birth date:___/___/___
Previous Street Address:_____________________________________________________Years there:______
City:_______________________________________State:_________________________Zip:_____________
Present Employer: ___________________________________Years there: _____Telephone:______________
Position or Title: ________________________________Name of Supervisor:__________________________
Employers Address:________________________________________________________________________
Present net salary or commission: $________________per______ No. of Dependents: _____Ages:_________
Alimony, child support, or separate maintenance need not Alimony, child support, separate maintenance
be revealed if you do not wish to have it considered as a received under: ____ court order ____ written
basis for repaying this obligation agreement ____ oral understanding
Other Income: $___________________per_________________. Source(s) of other income:_______________
Is any income listed in this Section likely to be reduced in the next two years or before the credit requested is paid
off? ____Yes (Explain in detail on a separate sheet.) ____ No
Checking Account No:___________________ Institution and branch:_______________________________
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Savings Account No.:___________________ Institution and branch:_____________________________
SECTION B - INFORMATION REGARDING SPOUSE, JOINT APPLICANT, USER
OR OTHER PARTY (Use separate sheets if necessary)
Full Name (Last, First, Middle):___________________________________________ Birth date: ___/___/___
Present Street Address:____________________________________________________Years there:________
City:_____________________________State:________Zip:____________Telephone:___________________
Social Security No:_______________________________ Drivers License No:_________________________
Previous Street Address: ___________________________________________________Years There:_______
City:_________________________________State:_________Zip:___________________________________
Present Employer: ________________________________Years there: _______Telephone:_______________
Position or Title: _____________________________Name of supervisor:_____________________________
Employer's address:_________________________________________________________________________
Present net salary or commission: $_______________per_______ No. of Dependents: _____ Ages: ________
Alimony, child support, or separate maintenance need not Alimony, child support, separate maintenance
be revealed if you do not wish to have it considered as a received under: ____ court order ____ written
basis for repaying this obligation agreement ____ oral understanding
Other Income: $______________________per_______. Source(s) of other income: _____________________
Is any income listed in this Section likely to be reduced in the next two years or before the credit requested is paid
off? ____ Yes (Explain in detail on a separate sheet.) ____ No
Checking Account No: _________________ Institution and branch:________________________________
Savings Account No.:___________________ Institution and branch: _______________________________
__________________________________________________________________________________
SECTION C - MARITAL STATUS
Applicant: ___ Married ___ Separated ___ Unmarried (including single, divorced, widowed)
Other Party: ___ Married ___ Separated ___ Unmarried (including single, divorced, widowed)
_________________________________________________________________________________
SECTION D – DEBTS (MUST BE FILLED IN)
Monthly expenses include the following (as applicable):
Current Mortgage $________________ Credit Cards $______________________
Car Payment $________________ Other debt payments $______________________
_________________________________________________________________________________________
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SECTION E – SECURITY
Property Address ________________________________________Present Market Value: _______________
Purpose of loan: _______________________________________________Tax valuation: ________________
Other loans on property within last 18 months:
Lender Amount Purpose Paid Off Payoff Date
___________________ ____________ _______________ Y N _____________
___________________ ____________ _______________ Y N _____________
___________________ ____________ _______________ Y N _____________
Names and addresses of all co-owners of the property:
_________________________________________________________________________________________
THERE ARE NO OTHER EQUITY LIENS ON THE PROPERTY
Everything that I have stated in this application is correct to the best of my knowledge. I understand that
you will retain this application whether or not it is approved. You are authorized to check my credit and
employment history and to answer questions about your credit experience with me.
________________________________ __________ _______________________________ __________
Applicants Signature Date Other Signature Date
___________________________________________________________________________________________________
LOAN WORKSHEET
APPRAISED VALUE $__________________ X 80% = $__________________
LESS OUTSTANDING DEBT------------------------------ $__________________________
MAXIMUM AMOUNT OF LOAN------------------------ $__________________________
_______________________________________________________________
ADDENDUM TO HOME EQUITY CREDIT APPLICATION
Thank you for your interest in a home equity loan from Southwest Securities, FSB. If any portion of the home
equity loan for which you are applying will be used to pay off an existing mortgage lien and/or to make home
improvements to the property. Southwest Securities, FSB must include this addendum to your application for
information collection purposes. Please read the following information pertaining to the Home Mortgage
Disclosure Act carefully.
______IN________________________________________________________________________
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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. 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
the above information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all
requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)
BORROWER CO-BORROWER
__ I do not wish to furnish this information. __ I do not wish to furnish this information.
ETHNICITY: ETHNICITY:
__ Hispanic or Latino __ Hispanic or Latino
__ Not Hispanic or Latino __ Not Hispanic or Latino
RACE: RACE:
___American Indian or Alaskan Native ___American Indian or Alaskan Native
___Asian ___Asian
___White ___White
___Black or African American ___Black or African American
___Native Hawaiian or Other ___Native Hawaiian or Other
___Pacific Islander ___Pacific Islander
SEX: SEX:
Female Male Female Male
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
to you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow
us to identify you. We may also ask to see your drivers license or other identifying documents.
The remainder of application to be completed by Bank
This application was taken by: _________________________________________________
Interviewer’s Name (Print or Type)
_____Face to Face Interview
_____Mail
_____Telephone
_____Internet _________________________________________________
Interviewer’s Signature
_____________________________________________________________
Interviewer’s Phone Number
Name of Interviewer’s Employer: Southwest Securities, FSB
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