HELOC Interest Questionnaire

Please provide the following information to help us better understand your needs and assess your eligibility for a Home Equity Line of Credit (HELOC).

First Name

Last Name

Phone *

Email *

Social Security Number *

Date of birth *

Address

Street Address

City

State

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea People's Democratic Republic
Republic of Korea
Kuwait
Kyrgyzstan
Land Islands
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Federated States of Micronesia
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Eswatini
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Postal code

Property Information

Home

Rent

Own (with Mortgage)

Own (with NO Mortgage)

Other

What type of property are you seeking the HELOC for?

Primary Residence

Investment Property (Rental/Second Home)

Property Address:

Year the property was purchased:

Estimated current market value of the property:

Outstanding mortgage balance(s)

Monthly mortgage amount

Property Tax amount

Is the property part of a HOA?

Yes
No
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If yes, amount of HOA annually.

Personal Information

What is your annual income? *

What is your credit score?

Excellent credit: 800 and higher
Very good credit: 740 to 799
Good credit: 670 to 739
Fair credit: 580 to 669
Poor credit: Below 580
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Do you have any outstanding debts (personal loans, credit card balances, student loans, etc.)?

Yes
No
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If yes, please list the debts and amounts:

What's your current debt-to-income ratio (DTI)/

Highest level of education

Last school attended

Graduation Year

Are you currently married?

Yes
No
Other
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If married, please list spouse's name.

HELOC Details:

What is the primary purpose of the HELOC?

Debt Consolidation
Home Improvement
Large Purchase
Medical Expenses
Car Repairs
Moving & Relocation
Taxes
Vacation
Wedding
Other
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How much credit would like to have available with your HELOC?

What repayment terms are you interested in?

Interest-only payments
Principal + Interest payments
Flexible repayment options
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Do you have a preference for a fixed or variable interest rate for your HELOC?

Fixed
Variable
No preference
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Are you aware of any liens, judgments, or pending legal actions associated with the property?

Yes
No
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Would you be interested in educational resources to improve your credit knowledge?

Select option

Yes
No
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You're Almost Done!

By checking this box, I understand and agree to terms & conditions of this submission

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