Equal Housing Lender | Member FDIC
Privacy Statement
Currently, we are only accepting online applications from within the state of Georgia.
Privacy Policy: Our privacy policy protects the privacy of your personal-identifying information that you provide us online.
The bank is required to provide adequate notice to new account customers, beneficial owners and the controlling person that the bank is requesting information to verify their identities. The notice describes the bank’s identification requirements and is posted in the lobby area to allow customers to view prior to opening an account. The following statement is the bank’s sign:
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 on personal accounts identifies each person who opens an account. In addition, on legal entity accounts, we will require identification on beneficial owners and controlling person.
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
If you request to open an account or become a signatory on an account with the Bank and the Bank has not previously verified your identity under the new regulatory requirements, the Bank will request documentary verification of your identity, such as driver’s license or passport and/or it will verify your identity through other non-documentary methods. Similar identification requirements apply to business entities such as corporations, limited liability companies and partnerships.
In all cases, protection of our customers’ identity and confidentiality is the Bank’s pledge to you.
Security Notice: ONLY fill out this loan application on-line if you are using a browser with the latest security enhancements. If you do not have the latest version, download it now. This form is NOT cached (saved in your computer's memory) when you QUIT your browser.
Instructions:
- Print this form and gather the information you'll need.
- Complete this form on-line and click "Submit Application".
- Upon receipt we will send you the proper disclosures, and charge your VISA or Master Card for $50.00 to cover the cost of processing this on-line form. We will also contact you to discuss your application within three business days.
- To safeguard your privacy, please QUIT your browser and restart it again after submitting this form.
This Residential Loan Application is for personal loans and is NOT intended for Business use.
This application is designed to be completed by the applicant(s) with the Lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower", as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when the income or assets of a person other than the "Borrower" (including Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.
| Agency Case No. | Lender Case No. | Amount $ | Interest Rate % | No. of Months | |
|---|---|---|---|---|---|
| Subject Property Address (street, city state & ZIP) | No. of Units | |
|---|---|---|
| Legal Description of Subject Property (attach description if necessary) | Year Built | |
|---|---|---|
| Year Lot Acquired | Original Cost $ | Amount Existing Liens $ | |
|---|---|---|---|
| (a) Present Value of Lot | (b) Cost of Improvements $ | Total (a+b) $ | |
|---|---|---|---|
| Year Acquired | Original Cost $ | Amount Existing Liens $ | Purpose of Refinance | |
|---|---|---|---|---|
| Describe Improvements | Cost $ | |
|---|---|---|
| Title will be held in what Names(s) | Manner in which Title will be held: | Source of Down Payment, Settlement Changes and/or Subordinate Financing (explain) | |
|---|---|---|---|
| Borrower's Name (include Jr. or Sr. if applicable) | Social Security No. | Home Phone (incl. area code) | Date of Birth | Yrs. School | |
|---|---|---|---|---|---|
| no. | ages | |
|---|---|---|
| Co-Borrower's Name (include Jr. or Sr. if applicable) | Social Security No. | Home Phone (incl. area code) | Date of Birth | Yrs. School | |
|---|---|---|---|---|---|
| no. | ages | |
|---|---|---|
| Name & Address of Employer | Years on this job | Yrs. employed in this line of work/profession: | Position/Title/Type of Business | Business Phone (include area code) | |
|---|---|---|---|---|---|
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
| Name & Address of Employer | Dates (from-to) | Monthly income: $ | Position/Title/Type of Business | Business Phone (incl. area code) | |
|---|---|---|---|---|---|
| Name & Address of Employer | Dates (from-to) | Monthly income: $ | Position/Title/Type of Business | Business Phone (incl. area code) | |
|---|---|---|---|---|---|
| Name & Address of Employer | Years on this job | Years employed in this line of work/profession: | Position/Title/Type of Business | Business Phone (incl. area code) | |
|---|---|---|---|---|---|
If employed in current position for less that two years or if currently employed in more than one position, complete the following
| Name & Address of Employer | Dates: from-to: | Monthly income: $ | Position/Title/ Type of Business | Business Phone (inc. area code) | |
|---|---|---|---|---|---|
| Name & Address of Employer | Dates: from-to: | Monthly income: $ | Position/Title/ Type of Business | Business Phone (inc. area code) | |
|---|---|---|---|---|---|
| Borrower | Co Borrower | Total | |
|---|---|---|---|
| Base Empl. Income * |
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| Overtime |
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| Bonuses |
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| Commissions |
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| Dividends/Interest |
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| Net Rental Income |
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| Other (before completing, see the notice in "describe other income" below) |
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| Total |
| Present | Proposed | |
|---|---|---|
| Rent |
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| First Mortgage (P & I) |
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| Other Financing(P & I) |
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| Hazard Insurance |
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| Real Estate Taxes |
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| Mortgage Insurance |
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| Homeowner Assn. Dues |
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| Other |
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| Total |
| Describe Other Income B/C | Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or co-Borrower(C) does not choose to have it considered for repaying this loan. | Monthly Amount | |
|---|---|---|---|
| B/C |
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| B/C |
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| B/C |
This Statement and any applicable supporting schedule may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If the Co-Borrower section was completed about a spouse, this Statement and supporting schedules must be completed about that spouse also.
| Cash deposit toward purchase held by:S Description | Cash or Market Value | |
|---|---|---|
| Name and address of Bank, S & L, or Credit Union | Acct. no. | Cash or Market Value | |
|---|---|---|---|
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| Stock & Bonds (Company name/number & description | Cash or Market Value | |
|---|---|---|
| Life Insurance net cash value Face amount: $ | Market Value | |
|---|---|---|
| Automobiles owned (make and year) | Cash or Market Value | |
|---|---|---|
| Other Assets (itemized) | Cash or Market Value | |
|---|---|---|
| Cash or Market Value | |
|---|---|
| Total Assets (a) |
Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.
| Name and Address of Company | Monthly Payt. & Mos. Left to Pay | Unpaid Balance | Acct. No. | |
|---|---|---|---|---|
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| Monthly Payt. & Mos. Left to Pay | |
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| Alimony/Child Support/Separate Maintenance Payments Owed to: |
| Monthly Payt. & Mos. Left to Pay | |
|---|---|
| Job Related Expense (child care, union dues, etc.) |
| Monthly Payt. & Mos. Left to Pay | |
|---|---|
| Total Monthly Payments |
| Monthly Payt. & Mos. Left to Pay | |
|---|---|
| Net Worth (a minus b) |
| Monthly Payt. & Mos. Left to Pay | |
|---|---|
| Total Liabilities(b) |
| Property Address | S - sold, PS- pending sale or R - rental being held for income | Type of Property | Present Market Value | Amount of Mortgage & Liens | Gross Rental Income | Mortgage Payments | Insurance Maintenance, Taxes & Misc. | Net Rental Income | |
|---|---|---|---|---|---|---|---|---|---|
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| Total |
| Alternative Name | Creditor Name | Account Number | |
|---|---|---|---|
| l. Other Credits (explain) | $ | |
|---|---|---|
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
| Yes | No | |
|---|---|---|
| Borrower |
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| Co-Borrower |
Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that:
(1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.;
(2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described herein;
(3) the property will not be used for any illegal or prohibited purpose or use;
(4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan;
(5) the property will be occupied as indicated herein;
(6) any owner or servicer of the Loan may verify or reverify any information contained in the application from any source named in this application, and Lender, its successors or assigns may retain the original and/or an electronic record of this application, even if the Loan is not approved;
(7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan;
(8) in the event that my payments on the Loan become delinquent, the owner or servicer of the Loan may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer credit reporting agencies;
(9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law;
(10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and
(11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a fascimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.
| Borrower's Name | Date | CO-Borrower's Name | Date | |
|---|---|---|---|---|
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
| Interviewer's Name | Interviewer's Phone Number (incl. area code) | Name and address of Interviewer's Employer | |
|---|---|---|---|