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Loan Application

* = Required Field

 

Borrower

* * *
*
*
* * * *
Yes
*How Long at Residence?
* * * *
*
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for for repaying this obligation.

 

Co-Borrower

 
How Long at Residence?
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for for repaying this obligation.

 

Type of Loan

*Please Select:

Amount to Borrow

 

At this time we can’t accept mortgage loan applications online, however, please click submit if you would like to have one of our loan officers speak with you about completing a home loan application.

 

 

 

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 not discriminate either on the basis of this information, or on whether you choose to furnish it. If you 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 and surname if you have made this application in person. If you do not wish to furnish the 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.)
BORROWER
Ethnicity: Hispanic or Latino
Race: American Indian or Alaska Native Black or African American Asian
Native Hawaiian or Other Pacific Islander White
Sex: Female Male
CO-BORROWER
Ethnicity: Hispanic or Latino
Race: American Indian or Alaska Native Black or African American Asian
Native Hawaiian or Other Pacific Islander White
Sex: Female Male

 

Branch Location

Select which Raccoon Valley Bank branch you would like to sign your documents in:
Loan Origination Company’s Name: Raccoon Valley Bank
Loan Origination Company Identifier: 407837
Loan Origination Company’s Address: 1202 Second St P.O. Box 129 Perry, IA 50220

Loan Originator’s Name Location Loan Originator Identifier Loan Originator’s Phone Number
Douglas Zeigler Adel 500948 515-993-4581
Thomas Book Adel 500956 515-993-4581
Warren Poldberg Adel 500951 515-993-4581
Thomas Heun Bagley 500950 641-427-5234
Christopher Watkins Dallas Center 1060726 515-992-9200
Randi Millsap Dallas Center 879225 515-992-9200
Charles Painter Perry 500952 515-465-3521
Daniel Rivera Perry 500953 515-465-3521
Randy Allen Perry 500956 515-465-3521

 

Credit Disclosures

An insurance product or annuity may be offered to you. If you purchase an insurance product or an annuity: (1) The insurance product or annuity is not a deposit or other obligation of, or guaranteed by, this institution or our affiliate(s); (2) With exception of Federal Flood Insurance or Federal Crop Insurance, the insurance product or annuity is not insured by the Federal Deposit Insurance Corporation or any other agency of the United States, this institution, or our affilate(s); and (3) In the case of an insurance product or annuity that invloves an investment risk, there is investment risk associated with the insurance product, including the possible loss of value. If an insurance product or annuity is offered we cannot condition an extension of credit on either of the following: (1) Your purchase of an insurance product or annuity from us or any of our affilates; or, (2) Your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.


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By clicking Submit I certify that everything I have stated in this Application is correct to the best of my knowledge. I understand that you will retain this Application whether or not it is approved. You are authorized to check my credit and employment history and answer questions about your credit experience with me.

Raccoon Valley Bank