Applicant. 2. Type of Requested Credit. l Monthly l Refinance. l Unsecured l To purchase property that will secure your credit

Transcription

1 Creditor ("You" means Appicant, et a; and "We" means Creditor) Individua Credit You are reying on your income or assets as we as income or assets from other sources. Appication Date Credit Type Line of Credit Loan Sae Lease Amount Loan Purpose Agricutura Business Consumer Credit Appication Important Information to Appicant(s). To hep the government fight the funding of terrorism and money aundering activities, federa aw requires a financia institutions to obtain, verify, and record information that identifies each person who appies for a oan or opens an account. What this means for you. When you appy for a oan or open an account, we wi ask for your name, address, date of birth and other information that wi aow us to identify you. We may aso ask to see your driver's icense or other identifying documents. In some instances, we may use outside sources to confirm the information. The information you provide is protected by our privacy poicy and federa aw. Read each instruction carefuy before competing this form. For Creditor Use Account No. Cass No. Date Received 1. Type of Appication Check ony one of the three types: Individua Credit You are reying soey on your income or assets. Joint Credit By initiaing beow, you intend to appy for "joint credit". Appicant Joint Appicant 2. Type of Requested Credit Financing Type No. of Months Repayment Interva First Payment Date New Monthy Refinance Modification Security for Credit Proceeds of Credit to Be Used for Unsecured To purchase property that wi secure your credit Secured To purchase property that is a residentia dweing and is not rea estate To finance home improvements to a residentia dweing Other (describe): Appicant Fu Name (First, Midde, Last) 3. Appicant Information Fu Name (First, Midde, Last) Joint Appicant or Other Party Gov't ID Type Gov't ID No. Gov't ID Issued By Gov't ID Issue Date Gov't ID Exp. Date Date of Birth Gov't ID Type Gov't ID No. Gov't ID Issued By Gov't ID Issue Date Gov't ID Exp. Date Date of Birth Primary Phone Ce Ce Primary Phone Ce Ce Emai Present Address Own Rent Emai Present Address Own Rent Previous Address Own Rent Previous Address Own Rent Dependents No.: Ages: Nearest Reative (not iving with you) Teephone: Ce Your Reationship to us (or our affiiate) None Empoyee Insider (Sharehoder, Director, Officer) Have you ever received credit from us? Yes No when: office/branch: Universa Credit Appication Bankers Systems Woters Kuwer Financia Services * VMP, 2012 Dependents No.: Ages: Nearest Reative (not iving with you) Teephone: Ce Your Reationship to us (or our affiiate) None Empoyee Insider (Sharehoder, Director, Officer) Have you ever received credit from us? Yes No when: office/branch: VMPC148 (1408).00 UCA 8/1/2014 Page 1 of 4

2 4. Asset and Debt Information If the "Joint Appicant" or "Other Party" Sections were competed, this Section shoud be competed by giving information about both the Appicant, and the Joint Appicant or Other Party, if appicabe. Assets Owned Type of Asset or Description Account Number Current Market Vaue Remaining Baance of Lien (Enter "0" if none) Asset Owner's Name Amounts from Continuation Form Tota Assets Outstanding Debts (This section shoud be charge accounts, instament contracts, credit cards, rent, mortgages and other obigations.) Creditor Name Type of Debt, or Account Number Origina Amount Present Baance Monthy Payment Debtor's Name Landord Rent Payment Mortgage Past Due (Yes/No) Amounts from Continuation Form Tota Debts Credit References Name Origina Amount Borrowed Date Paid in Fu Universa Credit Appication Bankers Systems Woters Kuwer Financia Services * VMP, 2012 VMPC148 (1408).00 UCA 8/1/2014 Page 2 of 4

3 Appicant 1st Empoyer: Current Previous Sef 5. Empoyment Information Joint Appicant or Other Party 1st Empoyer: Current Previous Sef Gross Monthy Saary/Comm.: Position/Tite: 2nd Empoyer: Current Previous Sef Gross Monthy Saary/Comm.: Position/Tite: 2nd Empoyer: Current Previous Sef Gross Monthy Saary/Comm.: Position/Tite: 3rd Empoyer: Current Previous Sef Gross Monthy Saary/Comm.: Position/Tite: 3rd Empoyer: Current Previous Sef Gross Monthy Saary/Comm.: Position/Tite: Gross Monthy Saary/Comm.: Position/Tite: Appicant 6. Other Income Joint Appicant or Other Party Aimony, chid support, or separate maintenance income need not be Aimony, chid support, or separate maintenance income need not be reveaed if you do not wish to have it considered as a basis for repaying reveaed if you do not wish to have it considered as a basis for repaying this obigation. this obigation. Aimony, chid support, separate maintenance received under: Aimony, chid support, separate maintenance received under: Court order Written agreement Ora understanding Court order Written agreement Ora understanding Other Income: Other Income: per Month per Month Source: Source: Is any income isted in Sections 4, 5 or 6 ikey to be reduced before the Is any income isted in Sections 4, 5 or 6 ikey to be reduced before the credit is paid off: credit is paid off: Yes (Expain in section 10.) No Yes (Expain in section 10.) No Appicant 7. Other Obigations Joint Appicant or Other Party Yes No Are you a comaker, endorser, cosigner, surety, or Yes No Amount: guarantor on any oan, contract or other obigation? Amount: For whom: For whom: Yes No Amount per month: Are there any unsatisfied judgments against you? Yes No Amount per month: Yes Where: Year: No Property Type Boat or Vesse Certificate of Deposit Deposit Account Manufactured Home Motor Vehice Primary Use of Property Agricutura Business Consumer Universa Credit Appication Bankers Systems Woters Kuwer Financia Services Yes No Amount per month: * VMP, Property Description Have you been decared bankrupt in the ast 10 years? Are you obigated to make Aimony, Support or Maintenance Payments? 8. Property Information (if secured) Residentia Dweing Homestead Property Property Owner(s) Names & Addresses 2012 Yes Where: Year: No Yes No Amount per month: Property Location and Address VMPC148 (1408).00 UCA 8/1/2014 Page 3 of 4

4 Appicant 9. Marita Status Joint Appicant or Other Party Leave bank, uness: (1) the credit wi be secured, or Leave bank, uness: (1) the credit wi be secured, or (2) you reside in a community property state, or (3) you are reying on property, ocated in a community property state, as a basis for repayment. (2) you reside in a community property state, or (3) you are reying on property, ocated in a community property state, as a basis for repayment. Married Separated Unmarried (incuding singe, divorced, widowed) 10. Additiona Information or Expanations Married Separated Unmarried (incuding singe, divorced, widowed) 11. Notices Caifornia Residents. Each appicant, if married, may appy for a separate account. New York Residents. A consumer report may be ordered in connection with your appication. Upon your request, we wi inform you whether or not a report was ordered. If a report was ordered, we wi te you the name and address of the consumer reporting agency that provided the report. Subsequent reports may be ordered or utiized in connection with an update, renewa or extension of credit for which you have appied. Ohio Residents. The Ohio aws against discrimination require a creditors make credit equay avaiabe to a creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individua upon request. The Ohio Civi Rights Commission administers compiance with this aw. Any person who, with intent to defraud or knowing that he is faciitating a fraud against an insurer, submits an appication or fies a caim containing a fase or deceptive statement is guity of insurance fraud. Texas Residents. The owner of the homestead is not required to appy the proceeds of the extension of credit to repay another debt except debt secured by the homestead or debt to another ender. Wisconsin Residents. Notice to Married Appicants. No provision of any marita property agreement, uniatera statement under Wisc. Statutes or a court decree under Wisc. Statutes adversey affects the interests of the Creditor uness the Creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actua knowedge of the adverse provision when the obigation to the Creditor is incurred. For Married Wisconsin Residents. The credit being appied for, if granted, wi be incurred in the interest of my marriage or famiy. I understand the Creditor may be required by aw to give notice of this transaction to my spouse. 12. Certifications, Authorizations and Signatures You certify that everything you have stated in this Credit Appication and on any other documents submitted to us are true and correct to the best of your knowedge. You understand that you must update the information contained in this Credit Appication if either your financia condition materiay changes or we make a request to you oray or in writing. You understand that we wi retain this Credit Appication whether or not it is approved. You authorize us to request one or more consumer reports, to check and verify your credit and empoyment history, and to answer questions others may ask us about our credit experience with you. You authorize us to contact you using any of the teephone numbers isted on this Credit Appication or that you subsequenty provide us in connection with your credit account regardess whether the number we use is assigned to a paging service, ceuar teephone service, speciaized mobie radio service, other radio common carrier service or any other service for which you may be charged for the ca. You further authorize us to contact you through the use of voice, text and emai and through the use of prerecorded/artificia voice messages or an automatic diaing device. Eectronic Signature. If checked, You further agree that you have signed this Credit Appication with one or more eectronic signatures. You intend your eectronic signature to have the effect of your written ink signature. You viewed and read the entire Credit Appication and notices before you signed it. You received a paper copy of this Credit Appication after it was signed. You understand that this Credit Appication is in the eectronic form that we wi keep. We may rey on, and enforce, this Credit Appication in the eectronic form or as a paper version of the eectronic form. Appicant Signature Date Joint Appicant, or Other Party, Signature Date (if appicabe) Notice: It is a federa crime punishabe by fine, imprisonment, or both, to knowingy make any fase statements concerning any of the above facts as appicabe under the provisions of Tite 18, United States Code 1001, et seq. Mortgage Loan Originator Information If this Credit Appication is secured by a consumer's residentia dweing that is owned by you, we may be required under federa or state aw to discose our mortgage oan origination identification number(s), which are as foows, if appicabe: } Mortgage Loan Originator Name and Identifier: } Mortgage Loan Origination Company Name and Identifier: For Creditor Use Date Received Received By Date Action Taken Action Taken By Action Taken Reason Code(s) Universa Credit Appication Bankers Systems Woters Kuwer Financia Services * VMP, 2012 VMPC148 (1408).00 UCA 8/1/2014 Page 4 of 4

5 Creditor ("You" means Appicant, et a; and "We" means Creditor) 1. CrossReference to Credit Appication Appication Date Account No. Credit Appication Addendum Continuation Form Cass No. Appicant Fu Name (First, Midde, Last) Appicant Present Address CoAppicant / Joint Appicant Fu Name (First, Midde, Last) CoAppicant / Joint Appicant Present Address Other Party 1 2. Other NonAppicant Parties Other Party 2 Compete this Section 2 (inc. subsections A, B, C) for parties who are not Appicants. Additiona Appicants shoud compete a separate oan appication. Party Type CoSigner Guarantor Party Type CoSigner Guarantor Fu Name (First, Midde, Last) Fu Name (First, Midde, Last) Gov't ID Type Gov't ID No. Gov't ID Issued By Gov't ID Type Gov't ID No. Gov't ID Issued By Gov't ID Issue Date Gov't ID Exp. Date Date of Birth Gov't ID Issue Date Gov't ID Exp. Date Primary Phone Ce Ce Primary Phone Ce Emai Emai Present Address Own Rent Present Address Own Rent Date of Birth Ce Other Party 1 A. Empoyment Other Party 2 Empoyer: Current Previous Sef Empoyer: Current Previous Sef Gross Monthy Saary/Comm.: Position/Tite: Other Party 1 C. Other Obigations Other Party 2 Yes No Are you a comaker, endorser, cosigner, surety, or Yes No Amount: guarantor on any oan, contract or other obigation? Amount: For whom: For whom: Yes No Amount per month: Phone Gross Monthy Saary/Comm.: Position/Tite: Other Party 1 B. Other Income Other Party 2 Aimony, chid support, or separate maintenance income need not be Aimony, chid support, or separate maintenance income need not be reveaed if you do not wish to have it considered as a basis for repaying reveaed if you do not wish to have it considered as a basis for repaying this obigation. this obigation. Aimony, chid support, separate maintenance received under: Aimony, chid support, separate maintenance received under: Court Order Written agreement Ora understanding Court Order Written agreement Ora understanding Other Income Other Income per Month per Month Source: Source: Is any income isted in subsections A or B or in section tited "Assets and Debt Information" on next page ikey to be reduced before the credit is paid off: Yes (Expain on next page) No Are there any unsatisfied judgments against you? Phone Is any income isted in subsections A or B or in section tited "Assets and Debt Information" on next page ikey to be reduced before the credit is paid off: Yes (Expain on next page) No Yes No Amount per month: Yes No Where: Year: Yes No Amount per month: Have you been decared bankrupt in the ast 10 years? Are you obigated to make Aimony, Support or Maintenance Payments? Yes Where: Year: No Yes No Amount per month: Credit Appication Continuation Addendum VMP, Bankers Systems* Woters Kuwer Financia Services 2012 VMPC148A (1202).00 UCAADDCON 2/15/2012 Page 1 of 2

6 Party Type. Indicate for whom this Asset and Debt Information is being provided: 3. Asset and Debt Information Appicant CoAppicant CoSigner Guarantor Assets Owned Type of Asset or Description Account Number Current Market Vaue Remaining Baance of Lien (Enter "0" if none) Asset Owner's Name Tota Assets Outstanding Debts (This section shoud be charge accounts, instament contracts, credit cards, rent, mortgages and other obigations.) Creditor Name Type of Debt, or Origina Amount Present Monthy Debtor's Name Account Number Baance Payment Past Due (Yes/No) Tota Debts Additiona Information or Expanations Signatures You acknowedge that the information contained on both pages of this Credit Appication Continuation Addendum is true and correct and further acknowedge that this Addendum is attached to, and made a part of, the crossreferenced Credit Appication and its credit fie which we wi retain. If a NonAppicant Party, you authorize us to request one or more consumer reports, to check and verify your credit and empoyment history, and to answer questions others may ask us about our credit experience with you. Signature Date Signature Date Credit Appication Continuation Addendum VMP, Bankers Systems* Woters Kuwer Financia Services 2012 VMPC148A (1202).00 UCAADDCON 2/15/2012 Page 2 of 2

7 Account No. Appicant or Other Party Fu Name (First, Midde, Last) Creditor's Work Sheet Cass No. Customer Information Fu Name (First, Midde, Last) Joint Appicant or Other Party Primary Phone Ce Ce Primary Phone Ce Ce Emai Emai Present Address Present Address Reationship to us (or our affiiate) Reationship to us (or our affiiate) None Empoyee Insider (Sharehoder, Director, Officer) None Empoyee Insider (Sharehoder, Director, Officer) Credit Decision Date Received Received By Date Action Taken Action Taken By Action Taken Reason Code(s) Other CoAppicants or Joint Appicants (if any) Other Parties Names & Addresses Cosigners (if any) Spouse (if Appicant is married and resides in community property state) Guarantors (if any) Dates Loan Date Terms of Credit Funding Date Maturity Date Credit Credit Type Misc. Fees Principa Amount Term Loan (Singeadvance) Officias: Cash Financed Term Loan (Mutiadvance) Prop Ins.: Cash Financed Line of Credit Lease Sae Prepaid Finance Charges Cash Financed Repayment Repayment Pan Demand Singe payment Instament payment Baoon f Amortized Term: Interest Ony Preferred/Discount Rate Feature AutoPayment: Deposit Account: Empoyee: first discounted discounted discounted discounted, or payments Payment Amount Fina Payment FeeinLieu of Interest Variabe Interest Rate Index and Margin Index Variabe Interest Rate Periodic Caps Variabe Interest Lifetime Rate Caps Index Rate: (subject to change) Margin: Interest rate increases wi: Increase payment amount Increase amount due at maturity Increase number of payments above beow Payment Frequency Singe Biweeky SemiMonthy Monthy Initia Adjustment Date: Initia Adj. Period: Initia Periodic Foor: Initia Periodic Cap: Subsequent Adj. Date: Subsqt. Adj. Period: Subsqt. Periodic Foor: Subsqt. Periodic Cap: Cash Cash Financed Financed except fina payment Interest Information Fixed Interest Rate f Simpe Fixed Interest Rate f Precomputed Precomputed Simpe Precomputed Addon Precomputed Discount Spit Rate Simpe / / Spit Rate Addon / / Discount through: Accrua Method Actua/365 Actua/Actua 30/360 Periodic pus any accrued and unpaid interest, principa and charges Lifetime Foor: Lifetime Cap: Interest RatePost Maturity Same Rate at Time of maturity unti paid unti paid Creditor Work Sheet Addendum VMP, Bankers Systems* Woters Kuwer Financia Services 2012 VMPC148B (1202).00 UCAADDCWS 2/15/2012 Page 1 of 2

8 Property Type Boat or Vesse Certificate of Deposit Deposit Account Manufactured Home Motor Vehice Property Description Residentia Dweing Coatera Homestead Property Property Location and Address Primary Use of Property Agricutura Business Consumer Debt Canceation Insurance Property Owner(s) Names & Addresses Insurance Credit Insurance Property Insurance Food Insurance None Singe Life Singe Life and A&H A&H ony Joint Life Joint Life and A&H Insurer: Coverage: Limits: Poicy No.: GAP Insurance Insurer: Coverage: Limits: Poicy No.: Other Insurance Account Baance Debt Verifications Monthy Pymt. Baance Empoyment 1st: 2nd: 3rd: Gross Wages/Saary/Commissions Other Income Monthy Income Tota Tota Assets Tota Assets and Liabiities Tota Liabiities (at time of Appication) Net Worth LoantoVaue (LTV) Tota LoantoVaue (TLTV) Ratios HometoIncome (HIR) DebttoIncome (DIR) Appicant or Other Party Not avaiabe Not avaiabe Not avaiabe Not avaiabe Name Name Name Name Consumer Reporting Agency Joint Appicant or Other Party Not avaiabe Not avaiabe Not avaiabe Not avaiabe Loan Officer's Comments Creditor Work Sheet Addendum VMP, Bankers Systems* Woters Kuwer Financia Services 2012 VMPC148B (1202).00 UCAADDCWS 2/15/2012 Page 2 of 2