Heat Pump Loan

Heat Pump/Weatherization Loan

With an approved credit check, Haywood EMC members may borrow up to
100% of the total cost for heat pump or weatherization loans. This loan is for a maximum
of 60 months with low interest financing. Loans will be billed as seperate items on your
electric bill. The current interest rate for this loan is 7.9%.

Loan Requirements

application
approved credit check
copy of your land deed
quote from licensed HVAC contractor with a "load calculation" report
ENERGY STAR 15 SEER or greater rated
$150.00 loan processing fee

Heat Pump/Weatherization Credit Application
Please Mail Completed Form to: Haywood EMC
1560 Asheville Road
Waynesville, NC 28786
or submit form below.

Online submission will require an additional phone
contact from Haywood EMC for more sensitive information.

Printer Friendly Form

Heat Pump/Weatherization Credit Application

HEMC ACCT #

Term of Loan
(Term of loan can be up to 5 Years at approximately 7.9% Interest

Years

Amount of loan requested

Email Address

Personal Information

Name

Spouse's Name

Is your SSN# on file with HEMC

Yes

Day Phone #

Address

City

State

How long at current address

Former Address

City

State

Applicant's Date Of Birth

/ /

Name, address, phone # of nearest relative not living with you and relationship

Employment Information

Present Employer

Years Employed

Address
State
Zip

Phone #

Supervisor's Name

Position/Title

Previous Employer

Years Employed

Address
State
Zip

Phone #

Supervisor's Name

Position/Title

Income Information

Salary

Net: $ per week/month/year

Gross: $ per week/month/year

Other Income

Source

** Alimony, child support or separate maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this loan.

Is any income listed likely to be reduced within the next two years? Yes
If yes, please explain:
**The applicant hereby authorizes Haywood EMC to investigate the applicant's credit history and to disclose credit information to credit reporting agencies.

	Location	Amount
Checking Account
Savings Account
Other

Outstanding Debts (PLEASE LIST EVERYTHING)

Type of Loan	Creditor Name	Monthly Payment	Date of Loan	Past Due Y or N
Credit Cards
Mortgage
Auto Loan
Insurance
Utilities
Other
Totals

Are there any other persons obligated on any of the above loans? Yes
If yes, which ones and who?
Are you a Co-Signer on any loans? Yes
If yes, for whom and to whom?
Have you declared bankruptcy on any loans? Yes
If yes, explain.
The applicant(s) hereby instruct Haywood EMC to treat the monthly loan repayments due hereunder the same as my (our) monthly bill for electric service. Default in payment of the loan will have the same effect as failure to pay for electrical service and will be cause for disconnection of electrical service, under the same conditions as apply to disconnection
regularly.

Signature of Applicant

Date