Home Equity Home Equity Line Of Credit (HELOC) Application

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Home EquityHome Equity Line of Credit (HELOC)Applicationwww.Bank-Northwest.com

WelcomeThank you for allowing Northwest Bank the opportunity to work on arrangingfinancing for your Home Equity/Home Equity Line of Credit loan. This applicationwill help you provide the information necessary to process your financial statementfor your Home Equity/Home Equity Line of Credit loan request. If you are not ableto provide all of the requested information immediately please provide the items thatare available and we will begin processing your request.This application may be printed and completed by hand or on a PC using AdobeAcrobat.Please complete, print, sign and return to Northwest Bank. If you choose to emailyour application, please follow the instructions on how to send your personal information securely at www.Bank-Northwest.com/SecureEmail. Thank you!Rev 9/19

CONSUMER LOAN APPLICATION (ORIGINATION VERSION) - EXTENDED GOV'T MONITORINGCredit Requested Is:Home Equity LoanAmount RequestedCollateral Secured LoanPersonal Unsecured LoanAccount Requested:Description of Collateral OfferedIndividualJointWe intend to apply for joint credit InitialPurpose of Credit RequestApplicantCo-ApplicantIf the Applicant is married, he or she may apply for individual credit. For Marital Status, check one if a) you are applying for a secured credit; b) you reside in a community property state;or c) you are relying on property in a community property state as a basis for repayment of the credit requested.ApplicantApplicant Role:BorrowerAPPLICANT INFORMATIONCo-SignerHome Phone (incl. area code)DOB (mm-dd-yyyy)Email AddressCo-SignerGuarantorSocial Security NumberHome Phone (incl. area code)DOB (mm-dd-yyyy)Email AddressMarriedDependents (not listed by Co-Applicant)Unmarried (includesingle, divorced, widowed)SeparatedCitizenship:BorrowerCo-Applicant Name (include Jr. or Sr. if applicable)Applicant Name (include Jr. or Sr. if applicable)Social Security NumberCo-ApplicantApplicant Role:GuarantorU.S. Citizenno.Permanent Resident AlienPresent Address (street, city, state, ZIP)MarriedagesDependents (not listed by Applicant)Unmarried (includesingle, divorced, widowed)SeparatedNon-Resident AliensinceCitizenship:U.S. CitizenPresent Address (street, city, state, ZIP)Mailing Address, if different from Present Addressno.agesPermanent Resident AlienNon-Resident AliensinceMailing Address, if different from Present AddressIf residing at present address for less than two years, complete the following:Former Address (street, city, state, ZIP)fromtoApplicantName & Address of EmployerFormer Address (street, city, state, ZIP)fromtoEMPLOYMENT / INCOME INFORMATION Co-ApplicantSelf EmployedYrs. on this jobName & Address of EmployerSelf EmployedYrs. on this jobFull timePosition/Title & Type of BusinessGross Monthly IncomeBusiness Phone (incl. area code) Name & Address of EmployerFull timePosition/Title & Type of BusinessGross Monthly IncomeSelf EmployedDatesBusiness Phone (incl. area code) Name & Address of EmployerSelf EmployedDatesfromfromtoPosition/Title & Type of BusinessName & Address of EmployertoBusiness Phone (incl. area code)Self EmployedDatesPosition/Title & Type of BusinessName & Address of EmployerBusiness Phone (incl. area code)Self EmployedDatesfromfromtoPosition/Title & Type of BusinessBusiness Phone (incl. area code)toPosition/Title & Type of BusinessBusiness Phone (incl. area code)NOTICE: 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.Other Income Other Income Other Income Other Income Other Income Other Income HOUSING INFORMATIONOwnRentsinceMonthly Housing/RentPresent Value Date PurchasedCASH ASSET INFORMATIONFinancial Institution NameSaving Account Balance Checking Account Balance 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 andcomplete, and that I/we did not omit any important 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 verifywith 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 informationas 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 Lenderto provide to any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.XXApplicantDateCo-ApplicantDate

ASSETS AND LIABILITIES ADDENDUM TO CONSUMER LOAN APPLICATIONApplicant:Application Number:AssetsChecking and Savings AccountsName & Address of InstitutionLiabilitiesName and Address of CreditorCash or Market ValueName & Address of CompanyPaymentBalanceAcct. No. Acct. No. Name & Address of InstitutionCash or Market ValueName & Address of CompanyPaymentBalanceAcct. No. Acct. No. Name & Address of InstitutionCash or Market ValueName & Address of CompanyPaymentBalanceAcct. No. Acct. No. Name & Address of InstitutionCash or Market ValueName & Address of CompanyPaymentBalanceAcct. No. Acct. No. Name & Address of InstitutionCash or Market ValueName & Address of CompanyPaymentBalanceAcct. No. Acct. No. Name & Address of CompanyPaymentBalance Acct. No. Name & Address of CompanyPaymentBalanceAcct. No. Name & Address of CompanyPaymentBalance Acct. No. Name & Address of CompanyPaymentBalance Acct. No. Alimony/Child Support/Separate Maintenance Owed to Job Related Expense Stocks and Bonds AssetsNumberDescriptionCash or Market Value Life Insurance - Face Value Real Estate Owned Assets Vested Interest in Retirement Funds Net Worth of Business Owned Automobiles Owned:YearMake and ModelCash or Market Value Other Assets Owned:DescriptionCash or Market Value LIQUID ASSETSTOTAL ASSETSNET WORTH "*" indicates obligations satisfied at or before loan closing.TOTAL MONTHLY PAYMENTSTOTAL LIABILITIES 0 0

REFERENCES ADDENDUM TO CONSUMER LOAN APPLICATIONApplicant:Application Number:ApplicantPERSONAL NameRelationshipAddressPhoneAddressPhoneINSURANCE DISCLOSURE FOR CREDIT APPLICATIONIMPORTANTDO NOT SIGN THIS FORM UNTIL YOU CAREFULLYREAD IT AND UNDERSTAND ITS CONTENTPurpose.You have submitted an application for a loan. In connection with your loan application, Lender may be soliciting, offering to sell, or will sell youan insurance product or annuity. Federal law requires Lender to provide you with the following disclosures.Credit Disclosures.1.Lender, as a condition of granting you a loan, cannot require that you purchase an insurance product or annuity from Lender or any of itsaffiliates.2.Lender, as a condition of granting you a loan, cannot require your agreement not to obtain or prohibit you from obtaining an insuranceproduct or annuity from an unaffiliated entity.Acknowledgment.BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, RECEIVED AND UNDERSTAND THIS INSURANCE Y SIGNING BELOW I ACKNOWLEDGE ON BEHALF OF THE LENDER THAT AN ORAL DISCLOSURE OF INSURANCE WAS DULY MADE TO THEAPPLICANT AND THAT APPLICANT ACKNOWLEDGED RECEIPT OF THE DISCLOSURE.LENDER:NORTHWEST BANKXAuthorized SignerTitle:Date

GOVERNMENT MONITORING / INTERVIEWER INFORMATION ADDENDUM TO CONSUMER LOAN APPLICATIONApplicant:Application Number:The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities andneighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for their demographic information(ethnicity, race, and sex) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. Youare not required to provide this information, but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or moredesignations for "Race". The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it.However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note yourethnicity, race, and sex on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age ormarital status information you provide in this application. If you do not wish to provide some or all of this information, please check below.Applicant:Co-Applicant:Ethnicity: Check one or moreHispanic or LatinoMexicanPuerto RicanCubanOther Hispanic or Latino - Print origin, for example,Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran,Spaniard, and so on:Ethnicity: Check one or moreHispanic or LatinoMexicanPuerto RicanCubanOther Hispanic or Latino - Print origin, for example,Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran,Spaniard, and so on:Not Hispanic or LatinoI do not wish to provide this informationRace: Check one or moreAmerican Indian or Alaskan Native - Print name ofenrolled or principal tribe:Not Hispanic or LatinoI do not wish to provide this informationRace: Check one or moreAmerican Indian or Alaskan Native - Print name ofenrolled or principal tribe:AsianAsian IndianChineseFilipinoJapaneseKoreanVietnameseOther Asian - Print race, for example,Hmong, Laottan, Thai, Pakistani, Cambodian, and so on:AsianAsian IndianChineseFilipinoJapaneseKoreanVietnameseOther Asian - Print race, for example,Hmong, Laottan, Thai, Pakistani, Cambodian, and so on:Black or African AmericanNative Hawaiian or Other Pacific IslanderNative HawaiianGuamanian or ChamorroSamoanOther Pacific Islander - Print race, for example,Fijian, Tongan, and so on:Black or African AmericanNative Hawaiian or Other Pacific IslanderNative HawaiianGuamanian or ChamorroSamoanOther Pacific Islander - Print race, for example,Fijian, Tongan, and so on:WhiteI do not wish to provide this informationWhiteI do not wish to provide this informationSex:FemaleMaleI do not wish to provide this informationSex:FemaleMaleI do not wish to provide this informationTo Be Completed by Financial Institution (for an application taken in person):Was the ethnicity of the applicant collected on the basis of visualobservation or surname?YesNoWas the ethnicity of the co-applicant collected on the basis of visualobservation or surname?YesNoWas the race of the applicant collected on the basis of visualobservation or surname?YesNoWas the race of the co-applicant collected on the basis of visualobservation or surname?YesNoWas the sex of the Applicant collected on the basis of visualobservation or surname?YesNoWas the sex of the co-Applicant collected on the basis of visualobservation or surname?YesNo

TO BE COMPLETED BY INTERVIEWERApplicant information was provided:Co-Applicant information was provided:In a face-to-face interviewIn a face-to-face interviewIn a telephone interviewIn a telephone interviewBy the applicant and submitted by fax or mailBy the applicant and submitted by fax or mailBy the applicant and submitted via e-mail or the internetBy the applicant and submitted via e-mail or the internetINTERVIEWER INFORMATIONOriginator NameOriginator NMLSR IdentifierPhone NumberOriginator License State and NumberCompany NameNorthwest BankCompany NMLSR IdentifierCompany License State and Number486668Company Address (street, city, state, ZIP)LaserPro, Ver. 17.4.10.006 Copr. D H USA Corporation 1997, 2017.All Rights Reserved.- C:\ProSuite\CFI\LPL\COLALNAP.FCExt.

financing for your Home Equity/Home Equity Line of Credit loan. This application will help you provide the information necessary to process your financial statement for your Home Equity/Home Equity Line of Credit loan request. If you are not able to provide all of the reques

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