Important Information About Opening an Account


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.

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 ask to see your driver's license or other identifying documents.

Please answer the following:
* required field, Do you intend to apply for Individual or Joint Credit?
Applicant

Applicant

Your personal information
* required field, Current Housing Situation
Employer
Your current employer
* required field, Preferred Method of Contact
* required field, Are you, or are you a dependent of someone who is presently on active military duty?
Co-applicant

Co-Applicant

Your personal information
* required if Joint, Current Housing Situation
Employer
Your current employer
* required if Joint, Preferred Method of Contact
* required if Joint, Are you, or are you a dependent of someone who is presently on active military duty?

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Applicant Income

Applicant Income Information

(Alimony, Child Support, or separate maintenance income need not be revealed, if you do not wish to have it considered as a basis for repaying this obligation.)

Other Gross Monthly Income

Other Gross Monthly Income

Other Income One
Other Income Two
Co-applicant Income

Co-Applicant Income Information

(Alimony, Child Support, or separate maintenance income need not be revealed, if you do not wish to have it considered as a basis for repaying this obligation.)

Other Gross Monthly Income

Other Gross Monthly Income

Other Income One
Other Income Two

Credit Request

Important Information You Need to Know When Applying For a Home Equity Line of Credit »
Current Monthly Payments
Are you a cosigner, endorser, or guarantor for anyone?
Will this loan be used for home improvement, refinance, or purchase of a 1-4 family residence?

Select NO if you are applying for a home equity line of credit or will be using the funds for a purpose other than home improvement, refinance, or purchase of a 1-4 family residence.

Select YES if this loan will be used for home improvement, refinance, or purchase of a 1-4 family residence.

By submitting this application, you are authorizing Merchants Bank, N.A. to respond electronically with a credit decision.

BY CLICKING SUBMIT, I AGREE: I/We hereby apply for the loan or credit described in this application. I/We certify that I/we made no misrepresentations in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose. Lender may disclose to any other interested parties information as to Lender's experiences or transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I/We further authorize Lender to provide to any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.

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