Fidelity Bank Home Equity Loan Application


Call 1 800 581 5363 to apply by Phone, or Fax to the Fidelity Bank office nearest you. Applications also accepted by Mail, or in Person at any location.
675 Main St Fitchburg
Fax 978 343-2031
29 Main St Leominster
Fax 978 537-0569
330 Main St. Gardner
Fax 978 632-0430
25 Main St Shirley
Fax 978 425-4358
97 Elm St Millbury
Fax 508 865-0940
Loan Details
 

Term
(for equity
loans only)
Amount Requested
$
 
Property Address
Title Held By
Date Purchased
Purchase Price
Mortgage Holder
Name/Address
Account Number
Balance
Monthly Payment
(including taxes)
Annual
Real Estate Tax
Annual Fire
Insurance Premium
  
Property Description:
Type
Number of Units
Number of Rooms
Number of Baths
Garage
Yes No
Land Acreage
Directions to Property
Purpose of Loan
Applicant 1
   
Applicant 2
Name
Phone Number
Name
Phone Number
Address
Years There
Address
Years There
City
Zip
City
Zip
Own Rent
Own Rent
Date of Birth
Social Security #
Date of Birth
Social Security #
Number of Dependents
Nearest Relative not living with you

Address
Number of Dependents
Nearest Relative not living with you

Address
Previous Address
(if less than 2 years at current address)
Years There
Previous Address
(if less than 2 years at current address)
Years There
Current Employer
Current Employer
Employer's Address
Employer's Address
Years There
Employer Phone Number
Years There
Employer Phone Number
Gross Monthly Income
Current Position
Gross Monthly Income
Current Position
Contact Person
Contact Person
If self employed, attach certified copies of tax returns for the last two (2) years.
If self employed, attach certified copies of tax returns for the last two (2) years.
Previous Employer
Years There
Previous Employer
Years There
Other Income
and Source
(Alimony, child support, or seperate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.)
Source

Amount


Written Agreement or
Oral Understanding?
Written Oral
Other Income
and Source
(Alimony, child support, or seperate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.)
Source

Amount


Written Agreement or
Oral Understanding?
Written Oral
Other Property Owned
Address
Number of Units
Rental Income
Account #
Balance
Mortgage Holder
Name/Address
Monthly Payment
Annual R/E Tax
Annual Insurance Cost
  
Are You a Bank Customer?
Yes No
Checking Account
Bank Name
Account #
Savings Account
Bank Name

Account #

Credit References:

Please list any banks, loan or finance companies that you now owe. List all other bills over $100. If none, state none. Give names of two (2) credit references whom you have paid on a monthly basis.
Name and Address
Account Number
Balance
Monthly Payments
 
I/We Understand that this is a Real Estate Mortgage.
 
Type "yes"
in this box
to agree to
these terms.
 
Should this loan be granted, I/We agree to comply with all the requirements of the Statutes and By-Laws and rules and regulations of the Board of Directors of the Fidelity Co-Operative Bank and agree to pay the expenses of an examination of the estate and title of the premises and Flood Hazard Certification. This loan shall become due and payable should the undersigned cease to occupy the property at any time during the term of the loan. I/We certify that I/We have no other debts except these listed herein, the above statements are true and complete, and I/We authorize you to obtain any information that you may require concerning such statements. I/We also agree that the application will remain the property of Fidelity Co-Operative Bank whether or not they approve the extension of credit. I/We further authorize you to furnish information concerning this application to credit reporting agencies and others who may properly receive that information.
Date

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