Home Equity Line of Credit Application Form

November 7, 2026

"*" indicates required fields

I am applying for:*

Amount Requested:*

Purpose:*

Repayment Method:*

Applicant Information

Name*

First Last

Driver's License Number and State*

Date of Birth*

Social Security Number*

Account Number (if applicable)

Home Phone*

Cell Phone*

Email*

Present Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you rent or own your present address?*

Length of Time at Present Address:*

Previous address if resided at present address less than 12 months

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Did you rent or own your previous address?

Length of Time at Previous Address:

Complete for Joint Credit

Married

Separated

Unmarried (Single, Divorced, Widowed)

List Ages of Dependents (exclude self)*

Co-Applicant Information

Name

First Last

Driver's License Number and State

Date of Birth

Social Security Number

Account Number (if applicable)

Home Phone

Cell Phone

Present Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you rent or own your present address?

Length of Time at Present Address:

Previous address if resided at present address less than 12 months

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Did you rent or own your previous address?

Length of Time at Previous Address:

Complete for Joint Credit

Married

Separated

Unmarried (Single, Divorced, Widowed)

List Ages of Dependents (exclude self)

Applicant Employment Information

Name of Employer*

Address of Employer*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title*

Supervisor's Name*

First Last

Start Date*

Number of hours worked per week*

If Self Employed, Type of Business

If employed with current employer less than five years, complete previous employer name and address

Previous Employment Start and End Date

Military Only: Is duty station transfer expected during the next year?

Military Only: If you answered yes to the previous question, what is the location and separation date for the transfer?

Co-Application Employment Information

Name of Employer

Address of Employer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Supervisor's Name

First Last

Start Date

Number of hours worked per week

If Self Employed, Type of Business

If employed with current employer less than five years, complete previous employer name and address

Previous Employment Start and End Date

Military Only: Is duty station transfer expected during the next year?

Military Only: If you answered yes to the previous question, what is the location and separation date for the transfer?

Applicant Income Information

Gross Monthly Income*

Other Income

Co-Applicant Income Information

Gross Monthly Income

Other Income

Applicant References

Name and address of nearest relative not living with you*

Relationship with nearest living relative not living with you*

Phone number of nearest living relative not living with you*

Co-Applicant References

Name and address of nearest relative not living with you

Relationship with nearest living relative not living with you

Phone number of nearest living relative not living with you

Applicant Assets

Checking Account Balance*

Checking Account Financial Institution Name*

Savings Account Balance*

Savings Account Financial Institution Name*

Co-Applicant Assets

Checking Account Balance

Checking Account Financial Institution Name

Savings Account Balance

Savings Account Financial Institution Name

I/ we attest that, to the best of my knowledge, I have provided accurate and complete information on this form. By clicking this box, I authorize NC Community Credit Union to pull my/our credit report as a part of working to get me/us pre-qualified for a residential mortgage.