HELOC/Home Equity Loan Application

USA PATRIOT Act Notice

IMPORTANT INFORMATION ABOUT 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 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.

Download / Print Version

HELOC/Home Equity Application
Phone 860-291-0345
Fax 860-282-5819
Email: loans@afncu.com
NOTE AND COMPLETE
NOTICE TO OHIO APPLICANTS: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.
WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property agreement, unilateral statement under Section 766.59, or count decree under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.
Signature For Wisconsin Residents Only
Date
Married Applicants may apply for a separate account.

INDIVIDUAL CREDIT: Complete Applicant section. Complete Co-Applicant, Spouse, (referred to as "Other") section: (1) about your spouse if you live in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI), or (2) if your spouse will use the Account. Please check box to indicate whom the information is about JOINT CREDIT: Each Applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant box.
Amount Requested
Purpose
Repayment:

Payroll Deduction Cash Automatic Payment Military Allotment Other
Please list Repayment Method
STATEMENT OF INTENT
Are you interested in having your loan protected?

Yes No
If you answer "yes", the credit union will disclose the cost to protect your loan. The protection is voluntary and does not affect your loan approval. In order for your loan to be covered, you will need to sign a separate application that explains the terms and conditions.
APPLICANT INFORMATION
Applicant
Last Name
First Name
M.I.
Driver's Licence Number/State
Date of Birth
Account Number
Social Security Number *
Home Phone
Cell Phone
Business Phone/Ext.
Email Address *
Present Address *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *
Ownership status *

Own Rent
Years at this residence *
Previous Address

Address Line 1

Address Line 2

City

State

Zip Code
Ownership Status

Own Rent
Years at this residence
Complete for Joint Credit, Secured Credit or if you Live in a Community Property State: *

Married Separated Unmarried (Single/Divorced/Widowed)
List Ages of Dependents Not Listed By Other Applicant (Exclude Self)
EMPLOYMENT INFORMATION
Name and Address of Employer
Your Title/Grade
Supervisor's Name
Start Date
Hours at Work
If Self Employed, Type of Business
If Employed Less Than Five Years, Complete Previous Employer Name and Address
Starting Date
Ending Date
MILITARY: Is Duty Station Transfer Expected Within Next Year

Yes No
Where
Ending/Separation Date
INCOME INFORMATION
NOTICE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income *
Per *
*

Net Gross
Other Income
Per
Net Gross
References

(Please include Street, City, State and Zip)
Name and Address of Nearest Relative Not Living With You *
Relationship *
Phone *
Name and Address of Personal Friend - Not a Relative *
Phone *
Will a Co-Applicant / Spouse be included on this Application?

Yes No
OTHER
Co-Applicant Spouse
Last Name
First Name
M.I.
Driver's License Number / State
Date of Birth
Account Number
Social Security Number
Home Phone
Cell Phone
Business Phone/Ext.
Present Address

Address Line 1

Address Line 2

City

State

Zip Code
Ownership Status

Own Rent
Years at this address
Previous Address

Address Line 1

Address Line 2

City

State

Zip Code
Ownership Status

Own Rent
Years at this address
Complete for Joint Credit, Secured Credit or if you Live in a Community Property State: *

Married Separated Unmarried (Single/Divorced/Widowed)
List Ages of Dependents Not Listed By Other Applicant (Exclude Self)
EMPLOYMENT INFORMATION
Name and Address of Employer
Your Title/Grade
Supervisor's Name
Start Date
Hours at Work
If Self Employed, Type of Business
If Employed Less Than Five Years, Complete Previous Employer Name and Address
Starting Date
Ending Date
MILITARY: Is Duty Station Transfer Expected Within Next Year

Yes No
Where?
Ending/Separation Date
INCOME INFORMATION
NOTICE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income
Per
Net Gross
Other Income
Per
Net Gross
REFERENCES

(Please include Street, City, State and Zip)
Name and Address of Nearest Relative Not Living With You
Relationship
Phone
Name and Address of Personal Friend - Not a Relative
Phone
ASSETS/PROPERTY

Check box for Applicant/Other. List all assets and account number(s)
Applicant Information
Share Draft or Checking Amount
Name and Address of Depository
Share Draft of Checking Amount
Name and Address of Depository
Asset/Location
Market Value
Collateral on another loan?

Yes No
Other assets e.g., Auto, Boat, Stocks, Bonds, Cash, Household Goods, Real Estate, etc.
Asset/Location
Market Value
Collateral on another loan?

Yes No
Asset/Location
Market Value
Collateral on another loan?

Yes No
Asset/Location
Market Value
Collateral on another loan?

Yes No
Asset/Location
Market Value
Collateral on another loan?

Yes No
Asset/Location
Market Value
Collateral on another loan?

Yes No
Other Information (Co-Applicant, Spouse)
Share Draft of Checking Amount
Name and Address of Depository
Share Draft or Checking Amount
Name and Address of Depository
Asset/Location
Market Value
Collateral on another loan?

Yes No
Other assets e.g., Auto, Boat, Stocks, Bonds, Cash, Household Goods, Real Estate, etc.
Asset/Location
Market Value
Collateral on another loan?

Yes No
Asset/Location
Market Value
Collateral on another loan?

Yes No
Asset/Location
Market Value
Collateral on another loan?

Yes No
Asset/Loation
Market Value
Collateral on another loan?

Yes No
Asset/Location
Market Value
Collateral on another loan?

Yes No
LIST EVERY LIEN AGAINST YOUR HOME -- This section must be completed for the property which will be given as security, if applicable.
A lien is a legal claim filed against property as security for payment of a debt. Liens include mortgages, deeds of trust, land contracts, judgments and past due taxes.
First Mortgage Held By
Present Balance
Other Liens

(Describe)
Is the property described in this section: Your principal dwelling?

HELOC/Home Equity Loan Application

USA PATRIOT Act Notice

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

HELOC/Home Equity Application

NOTE AND COMPLETE

STATEMENT OF INTENT

APPLICANT INFORMATION

Applicant

EMPLOYMENT INFORMATION

INCOME INFORMATION

References

OTHER

EMPLOYMENT INFORMATION

INCOME INFORMATION

REFERENCES

ASSETS/PROPERTY

Applicant Information

Other Information (Co-Applicant, Spouse)