Online Application

Please feel out the application form so that we may contact you at your convenience. For immediate personal attention, please call us at (256) 820-8422.
Applicant Information
Borrower Co-borrower
(If applicable)
Full Name 
Address 
City, State, Zip 
Home Phone 
Work Phone 
Best time to contact 
E-mail 
Employers 
Employers' Phone Number 
Are you self employed?  Yes No Yes No
Length of Employment 
Gross Monthly Income 
Date of Birth 
Social Security Number 


Loan Request
Amount Requested 
Type of loan  Purchase Refinance New Construction Home Equity  Other

Commercial Property  Consolidation  Working Farm Loan



Property Information
Street Address 
City, State, Zip Code 
Estimated Present Value 
Year Purchased 
Purchase Amount 
Type of Property  Primary Second/Vacation Investment


Loan Information
Mortgage Balances Amount Held by Payment Rate Term
First 
Second 
Other 


Current Bills
Bill Type Amount Owed Monthly Payment Will you pay this off ?
$ $ Yes No
$ $ Yes No
$ $ Yes No
$ $ Yes No


Comments
Other monthly debts, information or comments - please describe


By submitting this on-line application, I/We authorize Heritage Financial to check my/our credit, business and employment status and histories.