LOAN RATE MODIFICATION APPLICATION • I am applying for individual credit • We are applying for joint credit Please initial below. id BankWell 208 Elm St. New Canaan, CT 06840 (203) 972-3838 Applicant Co-Applicant Current Rate Modification Rate Request Purpose RATE REDUCTION APPLICANT CO-APPLICANT Feist Name Middle Initial Last Name First Name Middle Initial Last Name Street Address Street Address City/Town State Zip Code Cily/Town State Zip Code Former Address if less than 2 wars at current address Former Address if less than 2 years al current address City/Town State Zip Code City/Town State Zip Code Social Security Number Home Phone Number Social Security Number Home Phone Number Date of Birth Number of Dependents (including sell) Date ',Mirth Number of Dependents (including self) Nearest Relative not living with you Relationship Nearest Relative riot living with you Relationship APPLICANT OCCUPATION CO-APPLICANT OCCUPATION Employer Employer Address Work Phone Number Address Work Phone Number Position How Long Position How Long Former Employer if in current position less than 2 year% How Long Former Employer if in current position less than 2 years Now Long INCOME INCOME List sources of income below. Income from alimony or child support payments need not be revealed if you do not wish to have it considered as a basis for repaying this loan. List sources of income below. Income from alimony or child support payments need not be revealed if you do not wish to have it considered as a basis for repaying this loan. Gross Monthly Salary Gross Monthly Salary Commissions and Overtime Commissions and Overtime Dividend and Interest Dividend and Interest Rental Rental Other Other EQUAL HOUSING LENDER MEMBER FDIC EFTA00307537