HOME EQUITY LOAN OF CREDIT NOTE AND COMPLETE - Married Applicants may apply for a separate account NOTICE TO OHIO APPLICANTS: The ohio law against discrimination require that all creditors make credit equally available to 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 Individual Credit: Complete Applicant selection. 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.   you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about the person on whose payments you are relying. Joint Credit: If you are applying with another person, complete the Applicant and Other sections. Guarantor: Complete the Other section if you are a guarantor on an account/loan.   Amount Requested $_______________________________ Purpose/Collateral: _______________________________  Repayment: Payroll Deduction Cash Automatic Payment Military Allotment _______________ STATEMENT OF INTENT Are you interested in having your loan protected? YES NO If you answer "yes", then the credit union will disclose the cost of this voluntary payment protection to you. A separate election which discloses the terms and conditions must be signed for protection to be effective. APPLICANT INFORMATION  NAME (last - first - Initial)    ACCOUNT NUMBER  SOCIAL SECURITY NUMBER  DRIVER'S LICENSE NUMBER / STATE EMAIL ADDRESS BIRTH DATE HOME PHONE BUSINESS PHONE / EXT.   (     ) (     ) PRESENT ADDRESS (Street - City - State - Zip) OWN   RENT     LENGTH OF RESIDENCE PREVIOUS ADDRESS (Street - City - State - Zip) OWN   RENT     LENGTH OF 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 IN CURRENT POSITION LESS THAN FIVE YEARS, COMPLETE PREVIOUS EMPLOYER NAME AND ADDRESS   START DATE ENDING DATE MILITARY : IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR YES NO    WHERE           ENDING/SEPARATION DATE         NOTICE:  : ALIMONY CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED EMPLOYMENT INCOME OTHER INCOME $_______________ PER_______________ $_______________ PER_______________ NET GROSS   SOURCE______________________________ 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 OTHER INCOME $_______________ PER_______________ $_______________ PER_______________ NET GROSS   SOURCE______________________________ REFERENCES - Please include Street, City, State, and Zip NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU   RELATIONSHIP HOME PHONE NAME AND ADDRESS OF PERSONAL FRIEND - NOT A RELATIVE     HOME PHONE OTHER  Co-Applicant  Spouse Use "SAA" if information is "Same as Applicant"          NAME (last - first - Initial)    ACCOUNT NUMBER  SOCIAL SECURITY NUMBER  DRIVER'S LICENSE NUMBER / STATE EMAIL ADDRESS BIRTH DATE HOME PHONE BUSINESS PHONE / EXT.   (     ) (     ) PRESENT ADDRESS (Street - City - State - Zip) OWN   RENT     LENGTH OF RESIDENCE PREVIOUS ADDRESS (Street - City - State - Zip) OWN   RENT     LENGTH OF 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 IN CURRENT POSITION LESS THAN FIVE YEARS, COMPLETE PREVIOUS EMPLOYER NAME AND ADDRESS   START DATE ENDING DATE MILITARY : IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR YES NO    WHERE           ENDING/SEPARATION DATE         NOTICE:  : ALIMONY CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED EMPLOYMENT INCOME OTHER INCOME $_______________ PER_______________ $_______________ PER_______________ NET GROSS   SOURCE______________________________ 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 OTHER INCOME $_______________ PER_______________ $_______________ PER_______________ NET GROSS   SOURCE______________________________ REFERENCES - Please include Street, City, State, and Zip NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU   RELATIONSHIP HOME PHONE NAME AND ADDRESS OF PERSONAL FRIEND - NOT A RELATIVE     HOME PHONE ASSETS/PROPERTY - Check box for Application/Other. List all assets and account number(s) - Attach other sheets if necessary APPLICANT OTHER - (CO-APPLICANT, SPOUSE) SHARE DRAFT OR CHECKING AMOUNT $ NAME AND ADDRESS OF DEPOSITORY SHARE DRAFT OR CHECKING AMOUNT $ NAME AND ADDRESS OF DEPOSITORY SAVINGS AMOUNT $ NAME AND ADDRESS OF DEPOSITORY SAVINGS AMOUNT $ NAME AND ADDRESS OF DEPOSITORY Applicant LIST HOME AND ALL OTHER ITEMS YOU OWN AND LOCATION OF PROPERTY For Example: Auto, Boat, Stocks, Bonds, Cash, Household Goods, Real Estate, etc. MARKET VALUE PLEDGE AS COLLATERAL FOR ANOTHER LOAN Other HOME* $ YES NO $ YES NO $ YES NO This section must be completed for the property which will be given as a security. If applicable. LIST EVERY LIEN AGAINST YOUR HOME 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 OTHER LIENS (Describe) PRESENT BALANCE $   IS THE PROPERTY DESCRIBED IN THIS SECTION:   YOUR PRINCIPAL DWELLING? YES NO LISTED AS THE APPLICANT'S ADDRESS IN THE "APPLICANT INFORMATION" SECTION? YES NO IS ANYONE OTHER THAN YOUR SPOUSE A PART OWNER OF YOUR HOME? YES NO DEBTS - In addition to Rent/Mortgage list all other debits (for example, auto loans, credit cards, second mortgages, home assoc. dues, alimony, child support, child care medical, utilities, auto insurance, IRS liabilities, etc.) Please use a separate line for each credit card and auto loan. Attach other sheets if necessary. Applicant Creditor Name & Address Account # Original Balance Present Balance Monthly Payment Payment Date         Other   Rent Mortgage Incl. Tax & Ins.     $ $ $       $ $ $       $ $ $         $ $ $         $ $ $         $ $ $         $ $ $         $ $ $   FINANCIAL INFORMATION - These questions apply to both Applicant and Other   APPLICANT OTHER IF A "YES" ANSWER IS GIVEN TO A QUESTION. EXPLAIN ON AN ATTACHED SHEET YES NO YES NO DO YOU HAVE ANY OUTSTANDING JUDGMENTS? YES NO YES NO HAVE YOU EVER FILED FOR BANKRUPTCY OR HAD A DEBT ADJUSTMENT PLAN CONFIRMED UNDER CHAPTER 13? YES NO YES NO HAVE YOU HAD PROPERTY FORECLOSED UPON OR GIVIN A DEED IN LIEU OF FORECLOSURE IN THE LAST 7 YEARS? YES NO YES NO ARE YOU PARTY IN A LAWSUIT? YES NO YES NO ARE YOU OTHER THAN A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN? YES NO YES NO IS YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS? YES NO YES NO ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE? YES NO YES NO FOR WHOM (Name of Others Obligated on Loan): TO WHOM (Name of Creditor): SIGNATURES You promise that everything you have stated in this application is correct to the best of your knowledge. If there are any important changes you will notify use in writing immediately. You authorize the Credit Union to obtain credit reports in connection with this application for credit and any update, increase, renewal or extension of the credit received. You understand that the Credit Union will rely on the information in this application and your credit report to make its decision. If you request, the Credit Union will tell you the name and address of any credit bureau from which it received a credit report on you. It is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federal credit unions or state chartered credit unions insured by NCUA. If there are any important changes, you will notify us in writing Immediately. You also agree to notify us of any change in your name, address, employment within a reasonable time thereafter. X __________________________________________ X __________________________________________   Applicants Signature                                 Date   Other Signature                                 Date You Must Print, Sign, and Mail or Fax to Credit Union: Catoosa Teachers FCU 25 Gateway Business Park Drive Ringgold, GA 30736 706-965-6166 (Fax)