ConnectOneBank.com
Home Equity Line Of Credit Application
Thank you for your interest in a Home Equity Line of Credit with ConnectOne Bank. Attached, please find
your loan application.
Please complete and sign the attached application and Credit Authorization Form and email it to us at
consumerloans@cnob.com or fax it over to us at 908-206-2673.
If
you have any questions, please do not hesitate to reach out to us at 844-266-2548
HOME EQUITY LINE OF CREDIT APPLICATION
PLEASE PRINT OR TYPE
TYPE OF ACCOUNT REQUESTED
Check one to indicate the type of account you are requesting. Note: Married
applicants may apply for separate accounts.
Joint Account Individual Account - Relying solely on my income and assets.
□ Individual Account - Relying on my income and assets and as well as income or assets of
□ another.
Title in Name(s) of:
Address of Title Holder
Name and Address of Mortgage Holder
Phone No. Acct. No.
INDIVIDUAL
APPLICANT
INFORMATION
Name
Birthdate
I I
Social Security No.
Address
Drivers License No.
I
Home /Cell Phone
Number of Dep
County
endents
Ages of Dependents
Employer/Self-Employed
Position
Years Employed
Employer's Address
Years Employed
Previous Employer's Address
Previous Employer
Position
Name and Address of Applicant's Nearest Relative
Wages, Salary, Commissions
I
How Often Paid
Relationship
Gross$
..
/month Net$ /month
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have It considered. Alimony, child support,
separate maintenance received pursuant to:
□ Court Order □ Written.Agreement □ Oral Understanding
Other Income: Source Amount/Month
Marital Status Married Separated □ Unmarried (includes, single, divorced and widowed)
JOINT APPLICANT OR OTHER PARTY INFORMATION
Provide the information in this section for a joint applicant, another party that will use or contribute assets or income toward repayment on the account, or for your
spouse if you live in, or the collateral property is located in
AZ., CA, ID, LA, NM, NV, TX, WA, or WI.
Name
Blrthdate
I I
Social Security No.
Address
County
Drivers License No.
I
Home Phone Business Phone
I
Number of Dependents
Ages of Dependents
Employer/Self
-Employed
Position Years Employed
Employer's Address
Previous
Employer
Position Years Employed
Previous Employer's Address
I
Name and Address of Joint Applicant's or Other Party's Nearest Relative
Wages, Salary, Commissions
I
How Often Paid
Gross$
/month Net$ /month
Relationship
Alimony, child support, or separate maintenance Income need not be revealed if you do not wish to have It considered. Alimony, child support,
separate maintenance received pursuan
t to:
□ □ □ Court Order Written Agreement Oral Understanding
O
ther Income: Source Amount/Month
Marital Status □ Married □ Separated □ Unmarried (includes, single, divorced and widowed)
ASSET AND DEBT INFORMATION
If• Joint Applicant or Other Party Information• section was completed above, this section should be completed giving information about both the Applicant and the
Joint Applicant or Other Party. Please identify the Applicant-related information with an•••· Attach additional sheets if necessary.
ASSETS
DESCRIPTION OF ASSETS
NAME{S) OF OWNER{S)
SUBJECT TO DEBT: YES/NO
VALUE
Checking
Account Number(s)
(where)
$
Savings
Account Number(s)
(where)
Automobiles
(Make, Model, Year)
Marketable
Securities (Issuer, Type No. of Shares)
Life
Insurance
(cash
value)
Other
Real Estate (Location, when acquired)
Other
Assets (Describe)
Total
Assets
$
Speetralorm,
GalWOod,
NJ• 908-928-1220
I
Credit References
1.
$
Date Paid
2.
$
Date Paid
GENERAL INFORMATION
If you or a joint applicant or other party answers "yes• to any of the following questions, please explain in the
space provided. Are you a guarantor or co-maker of any leases, contracts of debts?
Are there any suits or judgments pending against you?
Yes
No
(include amount.,._
Have you been declared bankrupt in the last 1O years?
Yes No
PROPERTY
Location of Property Requiring Loan
Description of Property Age of Bldg. No. of Units
_
No. of rooms.
_
Date Purchased Cost$ Down Pay't $. Taxes$ Value$,
_
First Mtge. Date Held By Address
Original Amount$ Balance$
Monthly Pay't $ Taxes included? Up to Date?
_
Terms Rate
Improvements Since Purchase
_
Please indicate the number of rooms on each floor
Room List
Foyer
Living
Dining
Kitchen
Den
Family Rm
Rec Rm
Bedrooms
No. Baths
Laundry
Other
Total No. of Rooms
Basement
1st Level
2nd Level
HOMEOWNERS INSURANCE
INSURANCE COMPANY
EXPIRATION DATE AGENT'S NAME AND TELEPHONE
#
New York Resident's: A consumer report may be ordered in connection with your application. Upon your request, we will inform you whether or not a report was
ordered. If a report was ordered we will tell you the name and address of the consumer reporting agency that provided the report. Subsequent reports may be
ordered or utilized in connection with an update, renewal or extension of credit for which you have applied.
I certify that everything I have stated in this applicant and on any attachments is correct. You may keep this application whether or not it is approved, By signing
below I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that
I must update this credit information at our request and if my financial condition changes.
I acknowledge receipt of the Home Equity Brochure and the lender's Home Equity disclosure statement on today's date.
Applicant X.
Date._
.
,./
Joint-Applicant X Date._
./'------'/
_
CREDITOR
ACCOUNT
NUMBER
NAME IN WHICH THE
ACCOUNT IS CARRIED
ORIGINAL
AMOUNT
PRESENT
BALANCE
MONTHLY
PAYMENTS
Landlord or Mortgage Holder on
other
Real Estate
Auto
Loan
Auto
Loan
Credit or Charge Card
Credit or Charge Card
TOTAL DEBTS
$
$
$
Credit
Authorization
1. To all consumer-reporting agencies and to all creditors and depositories of the
undersigned:
Please be advised that the undersigned, and each of them, has made application
to:
ConnectOne Bank
requesting an extension of credit to the
undersigned.
Therefore, the undersigned, and each of them,
hereby
authorizes you to provide credit report and/or a disclosure to Lender or any agent or balance. The
undersigned
also authorizes you to disclose your deposit or credit experiences with the undersigned to Lender or to
third
parties.
2. In addition, the undersigned, and each of them, hereby authorizes Lender to disclose to any third party, or any
agent or employee thereof, information regarding the deposit or credit experience with any of the undersigned.
3. A photographic or carbon copy of this authorization bearing a photographic or carbon copy of the signature(s)
of
the undersigned may be deemed to be equivalent to the original hereof and may be used as a duplicate original.
B
orrower
Date Co-Borrower Date
__________________________________
__________________________________
Evidence of Joint Application
Date: __________________
Lender: ConnectOne Bank
Borrowers: __________________________________________________________
Property Address: _____________________________________________________
If you are applying for joint credit with another person, please sign below.
We intend to apply for joint credit.
Borrower Date
Co -Borrower Date