HELOC Update Form

HELOC ACCOUNT UPDATE FORM

Account and Borrower Information

Account Number:

Contact Information

Preferred Contact Method: Phone Email Mail

Type of Update Requested

Select the items you are requesting to update (select all that apply):

Address Change

Effective Date:

Employment and Income Update

Payment / ACH Authorization

If you are changing the account to which payments will be debited or credited, provide the bank information below and sign the authorization. The undersigned authorizes the lender to initiate electronic debit or credit entries to the account indicated and, if necessary, to initiate adjustments for any entries made in error. This authorization remains in effect until the lender receives written notice of revocation and has a reasonable opportunity to act upon it.

Account Type: Checking Savings

Authorized Users / Signers

Add Authorized User Name:

Relationship to Borrower:

Remove Authorized User Name:

Marital and Ownership Status

Marital Status: Single Married Separated Domestic Partner

Date of Transfer / Change (if applicable):

Tax Withholding / Taxpayer Identification

Do you request a change to tax withholding status for this account? Yes No

Power of Attorney / Legal Representation

If you are submitting this form on behalf of a Borrower under power of attorney, attach a certified copy of the power of attorney. By signing below the representative certifies they are authorized to act on behalf of the Borrower and will provide documentation upon request.

Certification, Authorization and Legal Notices

By signing below, the undersigned certifies that all information provided on this form is true, complete and correct to the best of their knowledge. The undersigned authorizes the lender and its agents to verify any information provided, to obtain credit reports and to contact employers, financial institutions and other third parties as necessary to effect the requested changes. The undersigned understands that additional documentation may be required to process certain updates (for example, recorded deeds for ownership changes, a certified power of attorney, or a voided check for ACH enrollment).

The undersigned acknowledges that completion of this form does not, by itself, modify the terms of the HELOC or release any borrower from obligations under the existing loan documents. Any change to the loan terms, credit limit, or collateral must be documented in a separate written agreement executed by the lender and all required parties.

False statements or omissions made in connection with this form may be subject to civil and criminal penalties under applicable law. The undersigned agrees to indemnify and hold the lender harmless from any losses arising from reliance on the information provided herein, except where such losses are caused by the lender's gross negligence or willful misconduct.

Supporting Documents

Required supporting documentation may include: certificate or recorded deed for ownership changes, recent pay stubs or tax returns for income updates, a voided check or bank letter for ACH enrollment, and a certified power of attorney where applicable. Do not send original title documents unless requested.

Acknowledgement and Signature

The undersigned certifies that they have the authority to request the updates set forth above and that the information provided is accurate. The undersigned agrees that the lender may rely on this document and the attached documentation until the lender receives written notice of any changes and has a reasonable period to act.

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