BNC National Bank Home Equity Line of Credit Application
Home Equity Line of
Credit Application
322 East Main Avenue
Bismarck, ND 58501
(70) 250-3000 “Lender”
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
or separate maintenance $ Other Monthly Household Income
$ Please describe the sources
of other household income.
Marital Status
Do not complete if this is an Application for individual unsecured credit. Applicant
Co-Applicant Married Separated Unmarried (including single, divorced, widowed)
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.
Savings Account No. Have you ever had a
judgment filed against you or declared
bankruptcy? YES Date: (Attach details )
NO Monthly child support or
separate maintenance payment $ Name of nearest relative
not living with you: Address Phone No. Relationship
ASSETS OBLIGATIONS
Assets Value Description Amount Owed Monthly Payment
Cash in Banks $ Unsecured Bank Loans $ $
Stocks or Bonds Secured Bank Loans
Automobiles Auto Loans
Real Estate Total Real Estate Obligations
Life Insurance (Face Value) $
Life Insurance Loans 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________________
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___________________________________________________ __________________Applicant’s Signature Date
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___________________________________________________ __________________Co-Applicant’s Signature Date
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BNC National Bank Home Equity Line of Credit 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 record).
[ 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 transaction.
The information if for the confidential use of the lender in determining my/our creditworthiness for a mortgage/consumer/ business purpose loan.
A PHOTOGRAPHIC COPY of the under sign’s authorization MAY BE DEEMED TO BE THE EQUIVALENT OF THE ORIGINAL and MAY BE USED AS A DUPLICATE ORIGINAL. The original signed form is maintained in the BNC NATIONAL BANK, 322 EAST MAIN, BISMARCK, ND 58501 OFFICE.
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
___________________________
Date
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)
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BNC National Bank Home Equity Line of Credit 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.
Date____________________
By:_____________________________________________
BNC National Bank Home Equity Line of Credit 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.
Date____________________
By:_____________________________________________
. Rev 10/10
FACTS
Why?
What?
How?
Questions?
WHAT DOES BNC NATIONAL BANK
DO WITH YOUR PERSONAL INFORMATION?
Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.
The types of personal information we collect and share depend on the product or service you have with us. This information can include:
n Social Security number and account balances
n Account transactions and checking account information
n Payment history and mortgage rates and payments
When you are no longer our customer, we continue to share your information as described in this notice.
All financial companies need to share customer personal information to run their everyday business. In the section below, we list the reasons financial companies can share their
customer personal information; the reasons BNC National Bank chooses to share; and whether you can limit this sharing.
For our everyday business purposes— such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus
For our marketing purposes— to offer our products and services to you
For our affiliates’ everyday business purposes— information about your transactions and experiences For our affiliates’ everyday business purposes— information about your creditworthiness
For joint marketing with other financial companies
For nonaffiliates to market to you
Go to www.bncbank.com
Yes No
Yes No
No We don’t share
No We don’t share
No We don’t share
No We don’t share
Reasons we can share your personal information Does BNC National
Bank share? Can you limit this sharing?
Who is providing this notice?
How does BNC National Bank protect my personal information?
How does BNC National Bank collect my personal information?
Why can’t I limit all sharing?
Affiliates
Non Affiliates
Joint marketing Page 2
Who we are
What we do
Defi nitions
BNC National Bank
To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings.
We collect your personal information, for example, when you
n Open an account or apply for a loan
n Make deposits or withdrawals from your account
n Use your ATM or Debit card or seek financial or tax advice
Federal law gives you the right to limit only
n sharing for affiliates’ everyday business purposes—information about your creditworthiness
n affiliates from using your information to market to you
n sharing for nonaffiliates to market to you
State laws and individual companies may give you additional rights to limit sharing.
Companies related by common ownership or control. They can be financial and nonfinancial companies.
n BNC National Bank does not share with our affiliates.
Companies not related by common ownership or control. They can be financial and nonfinancial companies.
n Nonaffiliates we share with can include mortgage companies and service providers that provide printing and mailing services in connection with our marketing to you.
A formal agreement between nonaffiliated financial companies that together market financial products or services to you.
n BNC National Bank doesn’t jointly market.
