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Honesdale National Bank
Home Equity Loan Application
Co-Applicant Home Information
Co-Applicant Additional Information
Information For Government Monitoring Purposes
Applicants must reside in Northeastern PA, Sullivan County New York or Delaware County New York.
Important Information about Procedures for Opening a New Account
Identification Procedures Requirements: To help the government fight the
funding of terrorism and money laundering activities, Federal law 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, address, date of birth, and other information that will allow us to
identify you. We may also ask to see your driver's license or other
You should ONLY fill out this form on-line if you are using a browser with the latest security enhancements. If you don't have the latest version, download a copy now. This form is NOT cached (saved in your computer's memory) when you QUIT your browser.
1. Print this loan application and gather the information you'll need.
2. Complete application on-line and click "Submit Application" or fax it to 570-253-5263.
3. To safeguard your privacy, QUIT your browser and restart it again after using this form.
This loan application is for personal loans only and is NOT intended for commercial use. A valid social security number is required to apply. Please review and gather the information you will need before completing this form. Upon receipt of the application, we will send you the proper disclosures.
Home Equity Loan Request
This section to be completed only for loans subject to reporting under the Home Mortgage Disclosure Act (HMDA).
HMDA loans are loans made for the following purposes: Home Purchase (secured), Home Improvement (secured or unsecured), or refinance of a loan secured by a 1-4 residential dwelling (regardless of purpose).
The following information is requested by the Federal government for certain types of loans related to a dwelling, in order to monitor the Lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it.
If you choose to furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this Lender is required to note the information on the basis of visual observation or surname.
If you do not wish to furnish the above information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)
I/We have completed this request for credit in consideration of Honesdale National Bank lending to me and/or others upon my guarantee. I/We certify that all information contained herein is accurate and complete to the best of my knowledge.
I/We authorize Honesdale National Bank to retain property of this application, to rely on the foregoing, to check and verify my credit, employment and salary history, to secure follow up credit reports concerning my credit worthiness and to exchange information about my account with proper persons, creditors and credit bureaus.
I authorize my employer (present and future), bank and other references listed above to release and/or verify information to Honesdale National Bank at any time. I acknowledge that this application is subject to approval of credit and acceptance by Honesdale National Bank. Should my request for credit and subsequent loan be approved, I agree to give Honesdale National Bank written notice immediately upon change of my name, address, employment or any other pertinent information contained herein.