Refinance/HELOC Form

Thank you for using our website for the Refinance/HELOC about which you have inquired. Using the website will facilitate and expedite the closing. Please fill out the form below carefully and correctly. You must fill out the Shareholder name as it appears on the stock certificate. You must fill out the Cooperative as it appears on the stock certificate. Upon completion please click the submit button. You will receive an email confirming that the closing process has commenced and upon receipt of all required document and compliance with the instructions set forth previously provided, you will receive further instructions.

Date
 mm/dd/yyyy
Cooperative Name
 (exactly as it appears on stock certificate)
Shareholder
 (exactly as it appears on stock certificate)
Premises Apt. No.
Premises Street Address
Premises City
Premises State
Premises Zip
No. Shares
Proprietary Lease Date
 mm/dd/yyyy
Shareholder Attorney
Shareholder Attorney Email
Shareholder Attorney Phone XXX-XXX-XXXX
Shareholder Attorney Fax Number
 XXX-XXX-XXXX
Existing Lender
Existing Loan Amount
Proposed Lender
Proposed Loan Amount
Appraised Value (from Appraisal)