Payment Assistance Request Form: Mortgage/HELOC

We're here to help you through this difficult time. When completing this form, please note:

  • All fields are required unless otherwise indicated.
  • Read the Bank of the West Privacy Policy to see how we manage personal information.
Loan Type
COVID Related?
Summary of Hardship

Please do not include personal information such as your Social Security Number or account number

Tell us where you live

Choose your state of legal residence. We can then give you information about the products and services available in your area.

Note: Bank of the West has branches only in the states listed in the drop-down. At this time, we only open accounts for individuals and businesses in these states.