APPLICANT INFORMATION Applicant's Full Name (First M.I. Last) Social Security Number Citizenship

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1 APPLICATION CREDIT REQUESTED Application Date Application ID Amount Requested Term Product Specific Purpose of Loan We intend to apply for Joint Credit. Borrower Co-Borrower What branch would you like to do business with? APPLICANT INFORMATION Applicant's Full Name (First M.I. Last) Social Security Number Citizenship Home Phone Number Date of Birth # of Dependents Relationship Cell Phone Number address Marital Status Check one if (a) you are applying for secured credit, (b) you reside in a community property state, or (c) you are relying on property in a community property state as a basis for repayment for the credit requested. Married Separated Unmarried (including single, divorced and widowed) ADDRESS INFORMATION Home Address (Street #, Street Address, City, State, Zip-code) Mailing Address Length at Residence Payment Resident Type (Own, Rent, Other) EMPLOYMENT INFORMATION Occupation / Title Phone Number Length of Employment Salary OTHER INCOME tice: Alimony, child support, or separate maintenance income need not be revealed by you if you do not wish to have it considered as a basis of repayment. You may reveal this type of income if you do wish to have it considered as a source of repayment. Applicant Description Amount Frequency Include Page 1

2 APPLICANT / BORROWER - QUESTIONS Applicant Question Explanation (200 Character limit - Please send an attached sheet if necessary.) Are there any outstanding judgments against you? Have you ever been declared bankrupt in the past 7 years? Have you had property foreclosed upon in the last 7 years? Are you party to a lawsuit? Are you obligated on any loan which resulted in foreclosure, etc? Are you presently delinquent or in default on any Federal debt, loan, etc? Are you obligated to pay alimony, child support, or separate maintenance? Is any part of the down payment borrowed? Are you a co-maker or an endorser on a loan? Have you ever had merchandise repossessed? Have you ever been denied credit with this lender previously? Do you intend to occupy the property as your primary residence? Page 2

3 Completion Instructions for Co-Applicants or Co-Borrowers (a) If you are applying for joint credit or will be permitted to use the account, complete the Co-Applicant section as a Co-Borrower. (b) If the Applicant is applying for individual credit, but relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete the Co-Applicant Information section, to the extent possible, providing information about the person on whose alimony, support or maintenance payments or income or assets the Applicant is relying. (c) If the Applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested, complete the Co-Applicant Information section with regard to the Applicant's spouse. CO-APPLICANT / CO-BORROWER INFORMATION Applicant's Full Name (First M.I. Last) Social Security Number Citizenship Home Phone Number Date of Birth # of Dependents Relationship Cell Phone Number address Marital Status Check one if (a) you are applying for secured credit, (b) you reside in a community property state, or (c) you are relying on property in a community property state as a basis for repayment for the credit requested. Married Separated Unmarried (including single, divorced and widowed) ADDRESS INFORMATION Home Address (Street #, Street Address, City, State, Zip-code) Mailing Address Length at Residence Payment Resident Type (Own, Rent, Other) EMPLOYMENT INFORMATION OTHER INCOME tice: Alimony, child support, or separate maintenance income need not be revealed by you if you do not wish to have it considered as a basis of repayment. You may reveal this type of income if you do wish to have it considered as a source of repayment. Applicant Description Amount Frequency Include Page 3

4 CO-APPLICANT / CO-BORROWER - QUESTIONS Applicant Question Explanation (200 Character limit - Please send an attached sheet if necessary.) Are there any outstanding judgments against you? Have you ever been declared bankrupt in the past 7 years? Have you had property foreclosed upon in the last 7 years? Are you party to a lawsuit? Are you obligated on any loan which resulted in foreclosure, etc? Are you presently delinquent or in default on any Federal debt, loan, etc? Are you obligated to pay alimony, child support, or separate maintenance? Is any part of the down payment borrowed? Are you a co-maker or an endorser on a loan? Have you ever had merchandise repossessed? Have you ever been denied credit with this lender previously? Do you intend to occupy the property as your primary residence? COLLATERAL DEPOSIT ACCOUNT Institution Name Account Number Balance Account Type Int. Rate Term Maturity Date Collateral Offered REAL PROPERTY Property Address County Year Built Number of Units Property Usage Value Collateral Offered Legal Description Page 4

5 INFORMATION FOR GOVERNMENT MONITORING PURPOSES The following information is required 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. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race and sex on the basis of visual observation or surname. If you do not wish to furnish this information, please check below. Applicant: I do not wish to furnish this information Co-Applicant: I do not wish to furnish this information Ethnicity: Hispanic or Latino t Hispanic or Latino Ethnicity: Hispanic or Latino t Hispanic or Latino Race American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Race American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Sex: Female Male Sex: Female Male APPLICANT'S SIGNATURE IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT. To help the government fight the funding of terrorism and money laundering activities, U.S. Federal law requires all financial institutions to obtain, verify, and record information that identifies each person (individual and business) 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. In order to qualify for a loan, the minimum requirements are that you be a U.S. resident, be at least 18 years of age, and have a consistent source of income. Loans submitted after 3PM EST or on non business days (Saturday, Sunday and Federal Holidays) will be processed on the next business day. By clicking the "Submit" button, you are consenting to the use of electronic records and signatures in this application and you expressly authorize Commerce Bank and Trust to contact you at the addresses and phone numbers you have provided in this application. In order to complete the processing of your application, we may obtain information necessary to evaluate your income, collateral value (if applicable), and credit history, which may include a consumer credit report. Upon request, we will tell you if a consumer credit report was ordered and the name and address of the Credit Reporting agency that furnished the report. You understand that subsequent credit reports may be requested and/or used in connection with an update, renewal, extension, review or for other legitimate purposes associated with your account. APPLICANT DATE CO-APPLICANT DATE 386 Main Street, Worcester, MA Commerce Bank is a registered service mark in Massachusetts of Commerce Bank & Trust Company. Commerce Bank member FDIC. Fair Housing / Equal Opportunity. All rights reserved. Revision 3/2013 Page 5