Home Equity Loan Application by xiuliliaofz


									                                                         322 East Main Avenue
                                                         Bismarck, ND 58501
                                                                                                                                                     Home Equity
                                                         (70) 250-3000 “Lender”                                                                  Loan Application
                                                                   Please tell us about yourself and co-applicant, if applicable
Applicant’s Name                                                                                       Co-Applicant’s Name

Home Address Number and Street                                     Yrs/Mos                             Home Address Number and Street                                      Yrs/Mos

City, State, Zip Code                                              County                              City, State, Zip Code                                               County

Social Security Number          Home Phone No.                      Date of Birth                   Social Security Number            Home Phone No.             Date of Birth

Driver’s License No.                    No. Dependents        Age of Dependents                        Driver’s License No.           No. Dependents       Age of Dependents
Applicant’s Previous Home Address                                                                                                                                          Yrs/Mos

                                                                                              About Your Job(s)
Business Name or Employer  Self Employed (Additional Information required)                         Co-Applicant’s Employer  Self Employed (Additional Information required)

Business Address Number and Street                                 Yrs/Mos                          Business Address Number and Street                                     Yrs/Mos
                                                                                                                                                                           City, State, Zip Code
Business Phone                                                     City, State, Zip                    Code          Business Phone                                        Position

Personal Monthly                                 Employment Income                                     Position                                                 Personal Monthly Employment Income
                                                 $                                                                                                              $
Previous Employer                                             Yrs/Mos                               Co-Applicant’s Previous Employer                                      Yrs/Mos

                                                                                         About Your Other Income
                    You need not disclose alimony, child support or separate maintenance income unless you want us to consider it for purposes of this application.
Annual Interest & Dividend Income         Monthly Child Support                       Other Monthly Household Income                  Please describe the sources
$                                         or separate maintenance      $              $                                               of other household income.
                                                                                                Marital Status
                                                              Do not complete if this is an Application for individual unsecured credit.
Applicant                Married        Separated      Unmarried (including single, divorced, widowed)
Co-Applicant             Married        Separated      Unmarried (including single, divorced, widowed)
                                                                               About Your Existing Loans and Accounts
 Rent Home
 Own Home in the following name(s):
Monthly Rent or Payment          Purchase Price                            Original Loan Amount                   Balance Owing                 Present Value                     Date Purchased
$                                $                                         $                                      $                             $
Name and address of Mortgage Holder or Landlord

Name of My Bank                                                                                     Checking Account No.                                    Have you ever had a
                                                                                                    Savings Account No.
judgment filed against you or declared         (Attach details )                                    Monthly child support or
bankruptcy?  YES Date:                         NO                                                 separate maintenance payment $
Name of nearest relative                                            Address                                              Phone No.                                    Relationship
not living with you:
                            ASSETS                                                                                                 OBLIGATIONS
               Assets                           Value                                    Description                                     Amount Owed                                  Monthly Payment
                                    $                               Unsecured                                                  $
Cash in Banks                                                                                                                                                          $
                                                                    Bank Loans
Stocks or Bonds                                                     Secured
                                                                    Bank Loans
Automobiles                                                         Auto Loans

Real Estate                                                         Total Real Estate Obligations

Life Insurance                                                      Life Insurance Loans
(Face Value) $
                                                                    Credit Card Debt
Retirement Funds, IRA’s                                             Other Obligations
Other Assets

Other Assets

                TOTAL ASSETS $                                                               TOTAL OBLIGATIONS                 $                                      $

                                                                                                          NET WORTH            $

I/We represent that this application is complete and accurate and fully reflects my/our financial condition on the date shown below. I/We authorize Lender to obtain a credit report
and any other information it deems necessary about my/our credit worthiness. I/We agree to notify Lender immediately, in writing, of any adverse change in my/our financial
condition. I/we understand that Lender will retain this Application whether or not it is approved.  Lender may share information about you with other organizations that are its
affiliates unless you direct Lender not to do so. If you do not want Lender to share such information with its affiliates, please initial here________________

7 ___________________________________________________                           __________________             7 ___________________________________________________                       __________________
    Applicant’s Signature                                                          Date                             Co-Applicant’s Signature                                                  Date

BNC National Bank                                                                                                                                               Home Equity Loan Application
Information Disclosure Authorization
To Whom it May Concern:

I/We hereby authorize you to release to BNC National Bank its successors and/or assigns, for verification purposes,
information concerning:

[X]      Employment history, dates, title, income, hours worked, etc…

[X]      Checking, savings, and investment accounts (including copies of statements, etc.).

[X]     Mortgage/Consumer/Business loan rating, (opening date, high credit, payment amount, loan balance, and payment

[X]     Personal and business records from accountants, attorneys, etc… that may have information required for the
        processing of a loan.

[X]     Any information deemed necessary in connection with a credit report for a mortgage/consumer/business loan

The information if for the confidential use of the lender in determining my/our creditworthiness for a mortgage/consumer/
business purpose loan.

ORIGINAL and MAY BE USED AS A DUPLICATE ORIGINAL. The original signed form is maintained in the BNC

Your prompt reply will help my/our loan transaction.

                                       EQUAL CREDIT OPPORTUNITY ACT NOTICE
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color,
religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract), because
all or part of the applicant’s income derives from any public assistance program, or because the applicant has in good faith exercised
any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning the
Department of Housing and Urban Development is the Federal Trade Commission, Equal Credit Opportunity, Washington, D.C.
20580. BNC National Bank is regulated by the Comptroller of the Currency, 2345 Grand Ave., Suite 700, Kansas City, MO 64108.

_____________________________________                            ____________________________________
             Signature	   	      	                      	        	      			Social	Security	Number	

______________________________________                           ____________________________________
             Signature	   	      	     	                         	      		Social	Security	Number	


I/we authorize BNC National Bank to share my/our account and application information as they deem appropriate to any
affiliate of BNC National Bank for marketing purposes.

                  ________________ (BORROWER(S)	INITIALS	REQUIRED	FOR	ACCEPTANCE)

BNC National Bank                                                    2                                     Home Equity Loan Application
Important Information

                             Procedures for opening a New 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 an account, we will ask you for your name, address, date of birth, and other
           information that will allow us to identify you. We may also ask to see your driver’s license or
           other identifying documents.



BNC National Bank                                           3                                 Home Equity Loan Application
Important Information

                                                      Account Number: _________________________________

                                             Disclosure Statement
          Borrowers of BNC National Bank are not required to obtain insurance from a particular insurance
          company. Any insurance required as a condition of the extension of credit by BNC National Bank may,
          without affecting approval of the application for an extension of credit, be purchased from an insurance
          company of the Borrower’s choice.



BNC National Bank                                                                         Home Equity Loan Application
Privacy Statement
At the BNCCORP, Inc. (BNC) family of financial service providers, which includes BNC National Bank, the
basis of each customer relationship is trust. You have chosen to do business with BNC and we are obligated to
honor that relationship with great care, beginning with the information you have chosen to share with us. We
believe your privacy should not be compromised. At the same time, we want to offer you the array of financial
products and services you need to accomplish your financial goals. We believe we can do both through the
privacy policy outlined below.

Recognition of Customer’s Expectation of Privacy
At BNC, we believe the confidentiality and protection of customer information is one of our fundamental
responsibilities. And while information is critical to providing quality service, we recognize that one of our most
important assets is our customers’ trust. Thus, the safekeeping of customer information is a priority for BNC.

Collection and Disclosure of Information
We collect, retain, and use information about you only where we reasonably believe it will help administer
our business or provide products, services, and other opportunities to you. We collect nonpublic personal
information about you from the following sources:
 • Information we receive from you on applications or other forms;
 • Information about your transactions with us, our affiliates, or others; and
 • Information we receive from a consumer reporting agency.
         We may disclose all of the information that we collect, as disclosed above, to companies that are
         affiliated with us. This internal sharing allows us to provide you with opportunities to obtain a wide
         variety of products and services from us. If you prefer that we don’t share nonpublic personal and
         credit-related information about you with the companies affiliated with us, you may choose to opt out.
         If you wish to exercise this right, please go to www.bncbank.com and click on the Privacy Statement
         link found at the bottom of the page. You can then complete the Opt Out Form and choose submit or
         email your request to us at web@bncbank.com. If you do not have internet access you may call 1-800-
         BNC-BANK (1-800-262-2265). Your choice to opt-out will be considered effective until it is revoked
         in writing. In accordance with the Fair Credit Reporting Act, we may share identifying information
         and information about your transactions and experiences within the BNC family whether or not you
         have opted out. For joint consumer accounts, any one of the joint account holders may exercise this

If you are a joint account holder and you exercise this right, your decision will also apply to others with whom
you jointly hold accounts.

We also may disclose the following information to companies that perform marketing services on our behalf or
to other financial institutions with whom we have joint marketing agreements:

  • Information we receive from you on applications address, and Social Security number;

BNC National Bank                                       5                              Home Equity Loan Application
                                                                                 Privacy Statement (cont.)

  • Information about your transactions with us, our affiliates, or others, such as your account balance, credit
    card usage, and payment history; and

  • Information we receive from a consumer reporting agency, such as your creditworthiness and credit history.

These companies and contractors are subject to confidentiality provisions and restrictions that prohibit using
information beyond the performance of the specified services on our behalf. We do not disclose any nonpublic
personal information about our customers or former customers to nonaffiliated third parties unless: 1) you
request or authorize it; 2) the information is provided to help complete a transaction initiated by you; 3) the
information is provided to a reputable credit bureau or similar information reporting agency; or 4) the disclosure
otherwise is lawfully permitted or required.

Maintenance of Accurate Information
We continually strive to maintain complete and accurate information about you and your accounts. Should you
ever believe that our records contain inaccurate or incomplete information about you, please notify us. We will
investigate your concerns and correct any inaccuracies.

Confidentiality and Security
At BNC, employee access to nonpublic personal information is limited to those employees with a need to know
such information to provide products and/or services to you. We maintain physical, electronic, and procedural
safeguards that comply with federal standards to guard your nonpublic personal information. Employees are
educated on the importance of maintaining the confidentiality of customer information and on these Privacy
Principles. Because of the importance of these issues, all BNC employees are responsible for maintaining the
confidentiality of customer information and employees who violate these Privacy Principles will be subject to
disciplinary measures.

Maintaining Customer Privacy in
Business Relationships with Third Parties
When BNC conducts business with third parties, it requires its vendors and suppliers to maintain similar
standards of conduct regarding the privacy of personally identifiable customer information provided to them.
Providing Privacy Information to Customers and Responding to Inquiries At BNC, we value our customer
relationships. We want you to understand how we use the information you provide and our commitment
to ensuring your personal privacy. If you have any questions about how BNC protects your confidential
information, please call BNC at 1-800-262-2265 or e-mail us at web@bncbank.com.

BNC National Bank                                                                    Home Equity Loan Application

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