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Home Equity Application

HOME EQUITY APPLICATION

IMPORTANT APPLICATION INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances, we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.

Type of Requested Account* Indicates Required Field

Please Select: *

Branch, Officer, and NMLS Information

Institution ID: 446252

Ackley Branch - Jessica Schipper - NMLS #1671274
Belmond Branch - Melanie Sopher - NMLS #1495203

Belmond Branch – Pat Fisher - NMLS #488213
Eldora Branch - Karisa Vaughn - NMLS# 1843887

Grundy Center Branch - Stephanie Kiewiet - NMLS #1032523

Iowa Falls Branch - Katie Carpenter - NMLS #1792267
Iowa Falls Branch - Anna Kielsmeier - NMLS #2025092
Iowa Falls Branch- Matt Ubben - NMLS #1901618

Iowa Falls Branch - Ricardo Perez Ibarra - NMLS# 2583203

Parkersburg Branch- Melanie Groeneveld - NMLS # 1090806

Parkersburg Branch- Kyle Rice - NMLS #483061

Terms Requested

Collateral/Property Information

Property Type

Borrower Information

Marital Status *
Former Address Type

Borrower Employment Information

If employed with current employer for less than two years, or if currently employed with more than one job, complete the following:

Co-Borrower Information

Co-Borrower Marital Status *
Former Address Type

Co-Borrower Employment Information

If employed with current employer for less than two years, or if currently employed with more than one job, complete the following:

Income

Gross Monthly Income

Borrower

Co-Borrower

Total

Describe Other Income

Monthly Amount

Base Income

Overtime/Bonus

Other Income

TOTAL

References

Insurance

Insurance Company for Collateral Property

Assets & Liabilities

Deposits and Investment Accounts

Real Estate Owned

Automobiles and Personal Property

Unsecured Liabilities

Paying with this loan
Paying with this loan
Paying with this loan
Paying with this loan
Are you obligated to pay alimony/child support or separate maintenance?

Additional

Are you a guarantor or co-maker of any leases, contracts, or debts? *
Are there any suits or judgments pending against you? *
Have you been declared bankrupt in the last 10 years? *

I certify that everything I have stated in this application and on any attachment is correct. Lender may keep this application whether or not it is approved. By submitting below I authorize Lender to check my credit and employment history and to answer questions others may ask Lender about my credit record with Lender. I understand that I must update this credit information at Lender's request and if my financial condition changes.

HELOC Brochure   HELOC Disclosures

By submitting this, I acknowledge receipt of the Home Equity Brochure and the Lender's Home Equity disclosure statement on today's date.

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