Home Equity Loan Request Form

* Required fields

Customer Information
Individual or Joint	Individual Joint
First Name*
Middle Initial
Last Name*
Street Address
City
State & Zip	,
Mailing Address* Please note that we accept applications from applicants that reside in our service area. Our service area is generally defined as Stephenson, Winnebago, Boone, Ogle and Carroll counties in Illinois.
City*
State & Zip*	,
Home Phone Number* (555-555-5555)
Day Time Phone Number (555-555-5555)
E-mail Address*

Joint Applicant Information
First Name*
Middle Initial
Last Name*
Street Address
City
State & Zip	,
Mailing Address*
City*
State & Zip*	,
Home Phone Number* (555-555-5555)
Day Time Phone Number (555-555-5555)
E-mail Address*

Home Equity Loan Information
Please State the Purpose of the Loan*
Requested Loan Amount*
Property Street Address to be Used as Collateral for Loan*
City*
State & Zip*	,
Signature (use only if printing and mailing)
Primary Applicant Signature
Joint Applicant Signature

CUSTOMER CONSENT & ACKNOWLEDGEMENT: By typing, printing, signing, and/or submitting this online form, I/we certify that everything I/we have stated in this form is correct. I/we understand that I/we will be contacted by a UNION Savings BANK ("Bank") representative to complete the application process. I/we understand that additional information will be required for processing. I/we agree to receive all disclosures, provide identification, and sign agreements/documents in person at the time I/we visit the Bank. I/we further understand that the Bank may also keep this form whether or not an account opening results. I hereby authorize the Bank to verify any information included in this application and allow access to all the accounts listed above on which I am an owner. This application may be submitted by either electronically or by mail. PRINT & SIGN to mail/drop off the application. Click here for a listing of locations. Applications may be mailed to: UNION Savings BANK, PO Box 540, Freeport, IL 61032 or returned to any UNION Savings BANK branch location. By submitting your application, electronically, in person or by mail, you acknowledge that you have read, understand and agree to all terms, conditions and disclosures provided by UNION Savings BANK for this application.