Home Improvement Loan Application

Type of Loan* Loan Amount*
Purpose of this Loan*

Credit Type*

Please Tell Us about yourself


Please Tell Us about the co-applicant (if any)


First Name* First Name
Middle Initial Middle Initial
Last Name* Last Name
Date of Birth (mm/dd/yyyy)* Date of Birth (mm/dd/yyyy)
Social Sec. Number* Social Sec. Number
Home Phone* Home Phone
E-Mail Address* E-Mail Address
Present Employer* Present Employer
Present Employers Address* Present Employers Address
Length of Employment* Length of Employment
Position* Position
Work Telephone* Work Telephone
Previous Employer (if current is less than 2 yrs) Previous Employer (if current is less than 2 yrs)
Length of Previous Employer Length of Previous Employer
Gross Monthly Salary (round to nearest dollar)* Gross Monthly Salary (round to nearest dollar)
Other Income Other Income
* Alimony, child support or seperate maintenance need not be revealed if you do not wish it to be considered as a basis for repaying this obligation

Please tell us about your property

(Property must be owner occupied)

Current Address

Previous Address

(if less than 2 years at current address)

Address* Address
City* City
State* State
Zip* Zip
Purchase Date (mm/dd/yyyy)* Property Type*
Cost of Property* Tax Assessment Value*
Do you currently have a mortgage?*
Name of Bank holding your mortgage
Current Loan Balance Monthly Payment
Do you currently have a home equity line/loan?*
Name of Bank holding your line/loan
Current Loan Balance Monthly Payment


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 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 law for the particular type of loan applied for.)





Please read the following statements carefully before submitting your application

The undersigned gives this information for the purpose of obtaining credit and authorizes Dedham Institution For Savings ("the Bank") to obtain information concerning any statements made herein from any credit bureau or other investigative agency. I/We understand that if the Bank approves my/ our request, a copy of the appropriate agreement form(s) stating the terms of my/our agreement(s) with the Bank will be furnished to me/us. If I/we fail to advise the Bank of any objection to the agreement and utilize the credit extended, the terms of the agreement will be binding upon me/us.