Digital Banking Sign In
Lock Icon

Real Estate Application



Please fill out the fields in the form to complete your online application process. Once submitted, one of our loan representatives will contact you within one business day to complete the process. Thank you for giving City National Bank the opportunity to serve you.


Eligibility


To apply for a loan online with City National Bank you must reside within our market area. Before proceeding, please input the zip code of your residence and confirm our eligibility below.

Customer Consent

I acknowledge and agree that I consent to receive account information electronically that is being provided in connect with a transaction affecting interstate commerce that is subject to the federal Electronic Signature in Global and National Commerce Act, and that I and the bank both intend that the Act apply to the fullest extent possible to validate our ability to conduct business with one another by electronic means.
Consent(Required)
View our Privacy Policy


Instructions to Applicant: Verify and complete the information on this application. If you are applying for this loan with others, each additional Applicant must provide information as directed by your Creditor. This application can collect information for up to two Applicants.

1. Type of Credit Application

Type of Credit App(Required)
By signing, you intend to apply for joint credit.
Applicant for Joint Credit
Co-Applicant for Joint Credit



2. Applicant Information

This section asks about your personal information and your income from employment and other sources, such as retirement, that you want considered to qualify for this loan.

2a. Personal Information

Name(Required)
List any names by which you are known or any names under which credit was previously received (First, Middle, Last, Suffix)



(or Individual Tax Payer Identification Number)
MM slash DD slash YYYY
U.S. Citizen(Required)
Resident Alien Status
(If U.S. Citizen is No)



MM slash DD slash YYYY
MM slash DD slash YYYY



Marital Status(Required)
(Single, Divorced, Widowed, Civil Union, Domestic Partnership, Registered Reciprocal Beneficiary Relationship.)
Not listed by another Applicant



Contact Information




Current Address



Years
Months



Housing



If at Current Address for LESS than 2 years, list Former Address

If at Current Address for LESS than 2 years, list Former Address
Former Address



Years
Months



Housing



Mailing Address

- if different from Current Address
If at Current Address for LESS than 2 years, list Former Address
Mailing Address



2b. Current Employment/Self Employment and Income

If at Current Address for LESS than 2 years, list Former Address
Address
MM slash DD slash YYYY
Check if this statement applies:



Gross Monthly Income

(per month)



Owner?
Ownership



2c. IF APPLICABLE, Complete Information for Additional Employment/Self Employment and Income

If at Current Address for LESS than 2 years, list Former Address
Address
MM slash DD slash YYYY
Check if this statement applies:



Gross Monthly Income

(per month)



Owner?
Ownership



2d. IF APPLICABLE, Complete Information for Previous Employment/Self-Employment and Income


Provide at least 2 years of current and previous employment and income
Untitled
Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Owner?



2e. Income from Other Sources

Untitled
Include income from other sources below. Under Income Source, choose from the sources listed in the drop-down box.

NOTE:
Reveal alimony, child support, separate maintenance, or other income ONLY IF you want it considered in determining your qualification for this loan.
Applicant Name



3. Financial Information - Assets and Liabilities

This section asks about things you own that are worth money and that you want considered to qualify for this loan. It then asks about your liabilities (or debts) that you pay each month, such as credit cards, alimony, or other expenses.



3a. Assets - Bank Accounts, Retirement, and Other Accounts You Have





3b. Other Assets and Credits You Have


Include all accounts below. Please choose from the options available in the drop-down box of the appropriate Type (Asset OR Credit)
Untitled



3c. Liabilities - Credit Cards, Other Debts, and Leases that You Owe


List all liabilities below (except real estate) and include deferred payments. Under Account Type, choose from the available types in the drop-down:
Untitled
Untitled



Untitled



Untitled



Untitled



Untitled



3d. Other Liabilities and Expenses


Include all other liabilities and expenses below. Choose from the types in the drop-down:
Untitled



Applicant Name



4. Financial Information - Real Estate

This section asks you to list all properties you currently own and what you owe on them.
Untitled



4a. Property You Own


If you are refinancing, list the property you are refinancing FIRST.
Address



if not included in Monthly Mortgage Payment



For 2-4 Unit Primary or Investment Property



Mortgage Loans on this Property
Untitled



Untitled



Untitled



4b. IF APPLICABLE, Complete Information for Additional Property

Untitled
Address



if not included in Monthly Mortgage Payment
For 2-4 Unit Primary or Investment Property



Mortgage Loans on this Property
Untitled



Untitled



Untitled



4c. IF APPLICABLE, Complete Information for Additional Property

Untitled
Address



if not included in Monthly Mortgage Payment



For 2-4 Unit Primary or Investment Property



Mortgage Loans on this Property
Untitled



Untitled



Applicant Name



5. Loan and Property Information

This section asks about the loan's purpose and the property you want to purchase, refinance, construct, improve or otherwise.



5a. Loan Purpose and Subject Property

Loan Purpose

Property Address
Occupancy



1. Mixed-Use Property. If you will occupy the property, will you set aside space within the property to operate your own business? (e.g., daycare facility, medical office, beauty/barber shop)
Untitled



2. Manufactured Home. Is the property a manufactured home? (e.g., a factory built dwelling built on a permanent chassis)
Untitled



5b. Other New Mortgage Loans on the Property You are Buying or Refinancing

Untitled
Lien Type



Lien Type



5c. Rental Income on the Property You Want to Purchase

For Purchase Only
Complete if the property is a 2-4 Unit Primary Residence or an Investment Property
Expected Monthly Rental Income



5d. Gifts or Grants You Have Been Given or Will Receive for this Loan


Include all gifts and grants below.
Does not apply
Deposited / Not Deposited
Deposited / Not Deposited



6. Declarations

This section asks you specific questions about the property, your funding, and your past financial history.



6a. About this Property and Your Money for this Loan

A. Will you occupy the property as your primary residence?
If YES, have you had an ownership interest in another property in the last three years?
If YES, complete (1) and (2) below:



B. If this is a Purchase Transaction: Do you have a family relationship or business affiliation with the seller of the property?



C. Are you borrowing any money for this real estate transaction (e.g., money for your closing costs or down payment) or obtaining any money from another party, such as the seller or realtor, that you have not disclosed on this loan application?



D. 1. Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on this loan application?
D. 2. Have you or will you be applying for any new credit (e.g., installment loan, credit card, etc.) on or before closing this loan that is not disclosed on this application?



E. Will this property be subject to a lien that could take priority over the first mortgage lien, such as a clean energy lien paid through your property taxes (e.g., the Property Assessed Clean Energy Program)?
Applicant Name



6b. About Your Finances

F. Are you a co-signer or guarantor on any debt or loan that is not disclosed on this application?



G. Are there any outstanding judgments against you?



H. Are you currently delinquent or in default on a Federal debt?



I. Are you a party to a lawsuit in which you potentially have any personal financial liability?



J. Have you conveyed title to any property in lieu of foreclosure in the past 7 years?



K. Within the past 7 years, have you completed a pre-foreclosure sale or short sale, whereby the property was sold to a third party and the Creditor agreed to accept less than the outstanding mortgage balance due?



L. Have you had property foreclosed upon in the last 7 years?



M. Have you declared bankruptcy within the past 7 years?
If YES, identify the type(s) of bankruptcy



7. State Notices

California Residents. California Civil Code 1812.30(j) requires we notify you that if you, the applicant, are married, you may apply for a separate account.

Massachusetts Residents. Under Massachusetts statute, Mass. Gen. L. ch. 184, Section 17B, you, the Applicant (and Co-Applicant) are entitled to know the following: 1. The responsibility of the attorney for the Mortgagee is to protect the interest of the Mortgagee. 2. Mortgagors may, at their own expense, engage an attorney of their own selection to represent their interests in the transaction.
For Home Equity Line of Credit. The current annual percentage rate for finance charges and, if the rate may vary, a statement to that effect and of the circumstances under which the rate may increase and whether there are any limitations on any such increase, as well as the effects of any such increase; the conditions under which a finance charge may be imposed, including the time period within which any credit extended may be repaid without incurring a finance charge; whether any annual fee is charged and the amount of any such fee; and whether any other charges or fees may be assessed, the purposes for which they are assessed, and the amounts of any such charges or fees.



New York Residents. A consumer report may be ordered in connection with your application. Upon your request, we will inform you whether or not a report was ordered. If a report was ordered, we will tell you the name and address of the consumer reporting agency that provided the report. Subsequent reports may be ordered or utilized in connection with an update, renewal or extension of credit for which you have applied.



Ohio Residents. Equal Credit Opportunity Notice: You are hereby provided the following "Equal Credit Opportunity" notice as required by Section 4112.021 of the Ohio Revised Code. "The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy 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."

Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.



Texas Residents. The owner of the homestead is not required to apply the proceeds of the extension of credit to repay another debt except debt secured by the homestead or debt to another lender.



Wisconsin Residents. Notice to Married Applicants. No provision of any marital property agreement, unilateral statement under Wisc. Statutes §766.59 or a court decree under Wisc. Statutes §766.70 adversely affects the interest of the lender unless the lender, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the lender is incurred.

For married Wisconsin Residents. The credit being applied for, if granted, will be incurred in the interest of my marriage or family. I understand the creditor may be required by law to give notice of this transaction to my spouse.



Applicant Name



8. Acknowledgments and Agreements

This section tells you about your legal obligations when you sign this application.
Definitions:
  • "Creditor" includes the Creditor's agents, service providers and any of their successors and assigns.
  • "Other Loan Participants" includes (i) any actual or potential owners of a loan resulting from this application (the "Loan"), (ii) acquirers of any beneficial or other interest in the Loan, (iii) any mortgage insurer, (iv) any guarantor, (v) any servicer of the Loan, and (vi) any of these parties' service providers, successors or assigns.


I agree to, acknowledge, and represent the following:

(1) The Complete Information for this Application
  • The information I have provided in his application is true, accurate, and complete as of the date I signed this application.
  • If the information I submitted changes or I have new information before closing of the Loan, I must change and supplement this application, including providing any updated/supplemented real estate sales contract.
  • For purchase transactions: The terms and conditions of any real estate sales contract signed by me in connection with this application are true, accurate, and complete to the best of my knowledge and belief. I have not entered into any other agreement, written or oral, in connection with this real estate transaction.
  • The Creditor and Other Loan Participants may rely on the information contained in the application before and after closing of the Loan.
  • Any intentional or negligent misrepresentation of information may result in the imposition of:
    (a) civil liability on me, including monetary damages, if a person suffers any loss because the person relied on any misrepresentation that I have made on this application, and/or
    (b) criminal penalties on me including, but not limited to, fine or imprisonment or both under the provisions of Federal law (18 U.S.C. §§ 1001 et seq.).

    (2) The Property's Security
  • The Loan I have applied for in this application will be secured by a mortgage or deed of trust which provides the Creditor a security interest in the property described in this application.


  • (3) The Property's Appraisal, Value, and Condition
  • Any appraisal or value of the property obtained by the Creditor is for use by the Creditor and Other Loan Participants.
  • The Creditor and Other Loan Participants have not made any representation or warranty, express or implied, to me about the property, its condition, or its value.


  • (4) Electronic Records and Signatures
  • The Creditor and Other Loan Participants may keep any paper record and/or electronic record of this application, whether or not the Loan is approved.
  • If this application is created as (or converted into) an "electronic application", I consent to the use of "electronic records" and "electronic signatures" as the terms are defined in and governed by applicable Federal and/or state electronic transactions laws.
  • I intend to sign and have signed this application either using my:
  • (a) electronic signature; or
    (b) a written signature and agree that if a paper version of this application is converted into an electronic application, the application will be an electronic record, and the representation of my written signature on this application will be my binding electronic signature.
  • I agree that the application, if delivered or transmitted to the Creditor or Other Loan Participants as an electronic record with my electronic signature, will be as effective and enforceable as a paper application signed by me in writing.


(5) Delinquency
  • The Creditor and Other Loan Participants may report information about my account to credit bureaus. Late payments, missed payments, or other defaults on my account may be reflected in my credit report and will likely affect my credit score.
  • If I have trouble making my payments I understand that I may contact a HUD-approved housing counseling organization for advice about actions I can take to meet my mortgage obligations.


(6) Authorization for Use and Sharing of Information
By signing below, in addition to the representations and agreements made above, I expressly authorize the Creditor and Other Loan Participants to obtain, use, and share with each other (i) the credit application and related credit information and documentation, (ii) a consumer credit report on me, and (iii) my tax return information, as necessary to perform the actions listed below, for so long as they have an interest in my loan or its servicing:
(a) process and underwrite my loan;
(b) verify any data contained in my consumer credit report, my credit application and other information supporting my credit application;
(c) inform credit and investment decisions by the Creditor and Other Loan Participants;
(d) perform audit, quality control, and legal compliance analysis and reviews;
(e) perform analysis and modeling for risk assessments;
(f) monitor the account for this loan for potential delinquencies and determine any assistance that may be available to me; and
(g) other actions permissible under applicable law.
Applicant Signature
MM slash DD slash YYYY
Applicant Signature
MM slash DD slash YYYY



9. Military Service

This section asks questions about your (or your deceased spouse's) military service.
Military Service - Did you (or your deceased spouse) ever serve, or are you currently serving, in the United States Armed Forces?
If YES, check all that apply:
MM slash DD slash YYYY



10. Demographic Information

Untitled



11. Loan Originator Information

To be completed by your Loan Originator.
Loan Originator Organization Name: City National Bank
Address: PO BOX 380, METROPOLIS, IL 62960
Loan Originator Organization NMLSR ID# 447217 State License ID# ____________
Loan Originator Name ____________
Loan Originator NMLSR ID# ____________ State License ID# ____________
Email ____________ Phone ____________
Signature
MM slash DD slash YYYY



Residential Credit Application - Continuation Sheet

Continuation Sheet

Use this continuation sheet if you need more space to complete the Residential Credit Application.
Applicant Name
Applicant Name
I/We fully understand that it is a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of federal law (18 U.S.C. §§ 1001 et seq.).
Applicant Signature
MM slash DD slash YYYY



Demographic Information Addendum.

This section asks about your ethnicity, sex, and race.

Demographic Information of Borrower

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or more designations for "Race." The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below.



Ethnicity: Check one or more
Sex
Race



Applicant Name



For Applicant Selecting the Unmarried Status

Creditors Instructions for Using the Unmarried Addendum
The Creditor may use the Unmarried Addendum only when an Applicant selected "Unmarried" in Section 2 and the information collected is necessary to determine how State property laws directly or indirectly affecting creditworthiness apply, including ensuring clear title.
For example, the Creditor may use the Unmarried Addendum when the Applicant resides in a State that recognizes civil unions, domestic partnerships, or registered reciprocal beneficiary relationships or when the property is located in such a State. "State" means any state, the District of Columbia, the Commonwealth of Puerto Rico, or any territory or possession of the United States.


If you selected "Unmarried" in Section 2, is there a person who is not your legal spouse but who currently has real property rights similar to those of a legal spouse?
If YES, indicate the type of relationship and the State in which the relationship was formed.

For example, indicate if you are in a civil union, domestic partnership, registered reciprocal beneficiary relationship, or other relationship recognized by the State in which you currently reside or where the property is located.
Applicant Name











Residential Credit Application - Additional Applicant


Instructions to Applicant: Verify and complete the information on this application. If you are applying for this loan with others, each additional Applicant must provide information as directed by your Creditor. This application can collect information for up to two Applicants.

1. Type of Credit Application

Type of Credit App(Required)
By signing, you intend to apply for joint credit.
Applicant for Joint Credit
Co-Applicant for Joint Credit



2. Applicant Information

This section asks about your personal information and your income from employment and other sources, such as retirement, that you want considered to qualify for this loan.



2a. Personal Information

Name
List any names by which you are known or any names under which credit was previously received (First, Middle, Last, Suffix)
(or Individual Taxpayer Identification Number)
MM slash DD slash YYYY
U.S. Citizen
Resident Alien Status



MM slash DD slash YYYY
MM slash DD slash YYYY



Marital Status(Required)
(Single, Divorced, Widowed, Civil Union, Domestic Partnership, Registered Reciprocal Beneficiary Relationship.)
Not listed by another Applicant



Contact Information




Address



Years
Months



Housing



If at Current Address for LESS than 2 years, list Former Address

Untitled
Former Address



Years
Months



Housing



Mailing Address

- if different from Current Address
Untitled
Mailing Address



2b. Current Employment/Self Employment and Income

Untitled
Employer or Business Name
Address
MM slash DD slash YYYY
Check if this statement applies:



Gross Monthly Income

(per month)



Untitled
Ownership



2c. IF APPLICABLE, Complete Information for Additional Employment/Self Employment and Income

Does not apply
Address
MM slash DD slash YYYY
Check if this statement applies:



Gross Monthly Income

(per month)



Untitled
Ownership



2d. IF APPLICABLE, Complete Information for Previous Employment/Self-Employment and Income


Provide at least 2 years of current and previous employment and income
Untitled
Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Untitled



2e. Income from Other Sources

Untitled
Include income from other sources below. Under Income Source, choose from the sources listed in the drop-down box.

NOTE:
Reveal alimony, child support, separate maintenance, or other income ONLY IF you want it considered in determining your qualification for this loan.
Applicant Name



3. Financial Information - Assets and Liabilities

(insert name of Applicant)



4. Financial Information - Real Estate

(insert name of Applicant)



5. Loan and Property Information

(insert name of Applicant)



6. Declarations

This section asks you specific questions about the property, your funding, and your past financial history.



6a. About this Property and Your Money for this Loan

A. Will you occupy the property as your primary residence?
If YES, have you had an ownership interest in another property in the last three years?
If YES, complete (1) and (2) below:



B. If this is a Purchase Transaction: Do you have a family relationship or business affiliation with the seller of the property?



C. Are you borrowing any money for this real estate transaction (e.g., money for your closing costs or down payment) or obtaining any money from another party, such as the seller or realtor, that you have not disclosed on this loan application?



D. 1. Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on this loan application?
D. 2. Have you or will you be applying for any new credit (e.g., installment loan, credit card, etc.) on or before closing this loan that is not disclosed on this application?



E. Will this property be subject to a lien that could take priority over the first mortgage lien, such as a clean energy lien paid through your property taxes (e.g., the Property Assessed Clean Energy Program)?



6b. About Your Finances

F. Are you a co-signer or guarantor on any debt or loan that is not disclosed on this application?



G. Are there any outstanding judgments against you?



H. Are you currently delinquent or in default on a Federal debt?



I. Are you a party to a lawsuit in which you potentially have any personal financial liability?



J. Have you conveyed title to any property in lieu of foreclosure in the past 7 years?



K. Within the past 7 years, have you completed a pre-foreclosure sale or short sale, whereby the property was sold to a third party and the Creditor agreed to accept less than the outstanding mortgage balance due?



L. Have you had property foreclosed upon in the last 7 years?



M. Have you declared bankruptcy within the past 7 years?
If YES, identify the type(s) of bankruptcy
Applicant Name



7. State Notices

California Residents. California Civil Code 1812.30(j) requires we notify you that if you, the applicant, are married, you may apply for a separate account.

Massachusetts Residents. Under Massachusetts statute, Mass. Gen. L. ch. 184, Section 17B, you, the Applicant (and Co-Applicant) are entitled to know the following:
  1. The responsibility of the attorney for the Mortgagee is to protect the interest of the Mortgagee.
  2. Mortgagors may, at their own expense, engage an attorney of their own selection to represent their interests in the transaction.
For Home Equity Line of Credit. The current annual percentage rate for finance charges and, if the rate may vary, a statement to that effect and of the circumstances under which the rate may increase and whether there are any limitations on any such increase, as well as the effects of any such increase; the conditions under which a finance charge may be imposed, including the time period within which any credit extended may be repaid without incurring a finance charge; whether any annual fee is charged and the amount of any such fee; and whether any other charges or fees may be assessed, the purposes for which they are assessed, and the amounts of any such charges or fees.



New York Residents. A consumer report may be ordered in connection with your application. Upon your request, we will inform you whether or not a report was ordered. If a report was ordered, we will tell you the name and address of the consumer reporting agency that provided the report. Subsequent reports may be ordered or utilized in connection with an update, renewal or extension of credit for which you have applied.



Ohio Residents. Equal Credit Opportunity Notice: You are hereby provided the following "Equal Credit Opportunity" notice as required by Section 4112.021 of the Ohio Revised Code. "The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy 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."

Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.



Texas Residents. The owner of the homestead is not required to apply the proceeds of the extension of credit to repay another debt except debt secured by the homestead or debt to another lender.



Wisconsin Residents. Notice to Married Applicants. No provision of any marital property agreement, unilateral statement under Wisc. Statutes §766.59 or a court decree under Wisc. Statutes §766.70 adversely affects the interest of the lender unless the lender, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the lender is incurred.

For married Wisconsin Residents. The credit being applied for, if granted, will be incurred in the interest of my marriage or family. I understand the creditor may be required by law to give notice of this transaction to my spouse.



8. Acknowledgments and Agreements

(insert name of Applicant)



9. Military Service

This section asks questions about your (or your deceased spouse's) military service.
MoveDuplicate Settings Delete Military Service - Did you (or your deceased spouse) ever serve, or are you currently serving, in the United States Armed Forces?
If YES, check all that apply:
MM slash DD slash YYYY



10. Demographic Information

Untitled
Applicant Name



11. Loan Originator Information

To be completed by your Loan Originator.
Loan Originator Organization Name: City National Bank
Address: PO BOX 380, METROPOLIS, IL 62960
Loan Originator Organization NMLSR ID# 447217 State License ID# ____________
Loan Originator Name ____________
Loan Originator NMLSR ID# ____________ State License ID# ____________
Email ____________ Phone ____________
Signature
MM slash DD slash YYYY



Residential Credit Application - Continuation Sheet

Continuation Sheet

Use this continuation sheet if you need more space to complete the Residential Credit Application.
Applicant Name
Applicant Name
I/We fully understand that it is a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of federal law (18 U.S.C. §§ 1001 et seq.).
Applicant Signature
MM slash DD slash YYYY
Additional Applicant Signature
MM slash DD slash YYYY



Demographic Information Addendum.

This section asks about your ethnicity, sex, and race.

Demographic Information of Borrower

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or more designations for "Race." The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below.



Ethnicity: Check one or more
Sex
Race



Borrower Name