10. Additional Information or Explanations
12. Certifications, Authorizations and Signatures
Married
Separated
Unmarried (including single, divorced, widowed)
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Ohio Residents. The Ohio laws against discrimination require all creditors make credit equally available to all creditworthy customers, and that
credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers
compliance with this law.
Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim
containing a false or deceptive statement is guilty of insurance fraud.
Leave blank, unless:
(1) the credit will be secured, or
(2) you reside in a community property state, or
(3) you are relying on property, located in a community property
state, as a basis for repayment.
Married
Separated
Unmarried (including single, divorced, widowed)
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Applicant Joint Applicant or Other Party
9. Marital Status
Electronic Signature. If checked, You further agree that you have signed this Credit Application with one or more electronic signatures. You
Leave blank, unless:
(1) the credit will be secured, or
(2) you reside in a community property state, or
(3) you are relying on property, located in a community property
state, as a basis for repayment.
Wisconsin Residents. Notice to Married Applicants. No provision of any marital property agreement, unilateral statement under Wisc. Statutes
§ 766.59 or a court decree under Wisc. Statutes § 766.70 adversely affects the interests of the Creditor unless the Creditor, prior to the time the
credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation
to the Creditor is incurred.
For Married Wisconsin Residents. The credit being applied for, if granted, will be incurred in the interest of my marriage or family. I understand
the Creditor may be required by law to give notice of this transaction to my spouse.
New York Residents. A consumer report may be ordered in connection with your application. Upon your request, we will inform you whether or
not a report was ordered. If a report was ordered, we will tell you the name and address of the consumer reporting agency that provided the
report. Subsequent reports may be ordered or utilized in connection with an update, renewal or extension of credit for which you have applied.
Texas Residents. The owner of the homestead is not required to apply the proceeds of the extension of credit to repay another debt except debt
secured by the homestead or debt to another lender.
California Residents. Each applicant, if married, may apply for a separate account.
11. Notices
You authorize us to contact you using any of the telephone numbers listed on this Credit Application or that you subsequently provide us in
connection with your credit account - regardless whether the number we use is assigned to a paging service, cellular telephone service,
specialized mobile radio service, other radio common carrier service or any other service for which you may be charged for the call. You further
authorize us to contact you through the use of voice, text and email and through the use of prerecorded/artificial voice messages or an automatic
dialing device.
Notice: It is a federal crime punishable by fine, imprisonment, or both, to knowingly make any false statements concerning any of the above facts
as applicable under the provisions of Title 18, United States Code § 1001, et seq.
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Mortgage Loan Originator Information
For Creditor Use
intend your electronic signature to have the effect of your written ink signature. You viewed and read the entire Credit Application and notices
before you signed it. You received a paper copy of this Credit Application after it was signed. You understand that this Credit Application is in
the electronic form that we will keep. We may rely on, and enforce, this Credit Application in the electronic form or as a paper version of the
electronic form.
If this Credit Application is secured by a consumer's residential dwelling that is owned by you, we may be required under federal or state law to
disclose our mortgage loan origination identification number(s), which are as follows, if applicable:
} Mortgage Loan Originator Name and Identifier:
} Mortgage Loan Origination Company Name and Identifier:
DateDate
(if applicable)
Applicant Signature Joint Applicant, or Other Party, Signature
Reason Code(s)Date Received Received By Date Action Taken Action Taken By Action Taken
You certify that everything you have stated in this Credit Application and on any other documents submitted to us are true and correct to the best
of your knowledge. You understand that you must update the information contained in this Credit Application if either your financial condition
materially changes or we make a request to you orally or in writing. You understand that we will retain this Credit Application whether or not it is
approved.
You authorize us to request one or more consumer reports, to check and verify your credit and employment history, and to answer questions
others may ask us about our credit experience with you.
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VMPC148 (1408).00
UCA 8/1/2014
Page 4 of 4
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VMP
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Universal Credit Application
2012Wolters Kluwer Financial Services
Bankers Systems