First Bank of Newton
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Home Equity Line of Credit Application

First Bank of Newton is located solely within the state of Kansas, county of Harvey, USA. Our trade area includes Harvey county and under certain circumstances neighboring counties including Sedgwick, Reno, Butler, McPherson and Marion. Applications outside our trade area will not be accepted through the Internet.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.

* Required Fields
Home Equity Line of Credit Application
$
Please read following directions before completing this application, and choose the appropriate circle.  
Check here if you are applying for individual credit. This means you are applying in your own name and are relying on your own income or assets, NOT those of another person as the basis for repayment.


Complete only the applicant information.
Check here if you are applying for joint credit. This means you are applying for credit with another person and will be relying on both your and their income or assets as the basis for repayment.

We intend to apply for joint credit.

Applicant:  (please initial)
Co-Applicant:  (please initial)
(Required if Joint Credit selected)


Complete both the applicant information and,
the co-applicant information.
Applicant Information
Yes No
/ /
(mm/dd/yyyy)
( ) -
Address Information

(If Military, APO, or FPO Address or if N/A, Next of Kin or Friend.)
* / /
/ /
/ /
If United States resident complete the section below
(if not proceed to next section)
- -    or   

/ /
(mm/dd/yyyy)

/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
Non United States residents complete all fields that apply in the section below
- -    or   
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
Applicant Financial Information
$
( ) -
$
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Married Separated Unmarried (single, divorced, widowed)
Yes No
/ /
( ) -
Co-Applicant Information
/ /
(mm/dd/yyyy)
( ) -
Address Information

(If Military, APO, or FPO Address or if N/A, Next of Kin or Friend.)
/ /
/ /
/ /
If United States resident complete the section below
(if not proceed to next section)
- -    or   
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
Non United States residents complete all fields that apply in the section below
- -    or   
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
/ /
(mm/dd/yyyy)
Co-Applicant Financial Information
$
( ) -
$
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Married Separated Unmarried (single, divorced, widowed)
Yes No
/ /
( ) -
Real Estate Information
/
(mm/yyyy)
$
$
$
$
List All Assets Owned
Note: Please provide the following information for both the Applicant and the Co-Applicant:
Cash
$
Yes No
Automobiles (Make, Model, Year)
$
Yes No
Automobiles (Make, Model, Year)
$
Yes No
Cash Value of Life Insurance (Issuer, Face Value)
$
Yes No
Real Estate (Location, Date Acquired)
$
Yes No
Marketable Securities (Issuer, Type, No. of Shares)
$
Yes No
Other (List)
$
Yes No
$   
Co-Applicant
Cash
$
Yes No
Automobiles (Make, Model, Year)
$
Yes No
Automobiles (Make, Model, Year)
$
Yes No
Cash Value of Life Insurance (Issuer, Face Value)
$
Yes No
Real Estate (Location, Date Acquired)
$
Yes No
Marketable Securities (Issuer, Type, No. of Shares)
$
Yes No
Other (List)
$
Yes No
$   
Outstanding Debts
Note: Include charge accounts, installment contracts, credit cards, rent mortgages, etc.
Creditor
Type of Debt
or Account #
Name in
Which Account
is Carried
Original
Debt
$
Present
Balance
$
Monthly
Payments
$
Past
Due?
Landlord or Mortgage Holder
Rent
Mortgage
(Omit Rent)
(Omit Rent)
(Rent)
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Total Debts:  
$
 


Explain:
*
Yes
No
If "Yes", For Whom:
To Whom:
*
Yes
No
If "Yes", To Whom Owed:
Amount:
$
Yes
No
If "Yes", Where:
What Year:
 
 
By signing below, I certify that the information provided in this Credit Line Application is correct and I authorize Bank to verify such information, to obtain credit reports, to verify any other credit references, and to make such other investigation as the Bank deems appropriate. UPDATED FINANCIAL INFORMATION: Bank may request from reporting agencies from time to time credit reports on me and request new financial information directly from me or from others for the purpose of updating Bank's records. I agree to promptly provide such financial information to Bank. Bank may rely on such information to make credit decisions concerning my line of credit. I agree to notify Bank of any adverse change in my financial condition.
 
Applicant Signature:*
 
Co-Applicant Signature:
 
 





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FIRST BANK
4 Locations in Newton & Hesston to Serve You
316-283-2600

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©2012 First Bank of Newton, all rights reserved. Please see our Internet User Agreement. First Bank of Newton is the full legal name of First Bank, located in Newton and Hesston, Kansas.

Harvey County's Oldest Bank... Established 1873