| Credit Application - Please fill out online, print, and bring in to our offices. | ||||||||||||||||||||||||||
Type of Credit Requested:
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Century Bank |
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| Section A - Individual Applicant Information |
| Name: Last: M.I.: First: |
| Birth Date: Tel. No. Soc. Sec. No. |
| Present Address:
City:
State:
Zip:
County: How Long |
| Previous Address:
City:
State:
Zip:
County: How Long |
| Have you applied for credit with us before?
No
Yes If Yes, then when? No. Dep. Dep. Ages |
| Name of Nearest Relative Not Living With You: Relationship |
| Address: Tel. No. |
| Employer (Company Name & Address) How Long |
| Bus. Tel. Position/Title How Often Paid? Take Home Salary Per Month $ |
| Previous Employer (Company Name & Address) How Long |
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Alimony, child support, separate maintenance received under: Court Order Written Agreement Oral Understanding Sources of Other Income: Amount Per Month: |
| Section B - Joint Applicant or Other Party Information | |
| Complete only if: for joint credit, for individual credit relying on income of assets from other sources, or applicant is married and resides in a community property state. | |
| Name: Last: M.I.: First: | |
| Birth Date: Tel. No. Soc. Sec. No. | |
| Present Address:
City:
State:
Zip:
County: How Long |
|
| Previous Address:
City:
State:
Zip:
County: How Long |
|
| Have you applied for credit with us before?
No
Yes If Yes, then when? No. Dep. Dep. Ages |
|
| Name of Nearest Relative Not Living With You: Relationship | |
| Address: Tel. No. | |
| Employer (Company Name & Address) How Long | |
| Bus. Tel. Position/Title How Often Paid? Take Home Salary Per Month $ | |
| Previous Employer (Company Name & Address) How Long | |
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Alimony, child support, separate maintenance received under: Court Order Written Agreement Oral Understanding Sources of Other Income: Amount Per Month: |
|
| Section C - Marital Status | |
Complete only if: for joint or secured credit, or applicant resides in a community property state or is relying on property located in such a state. (*Includes single, divorced and widowed) |
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| Applicant: Married Separated Unmarried* | Applicant: Married Separated Unmarried* |
| Section D - Asset & Debt Information | ||
| If Section B has been completed, this Section should be completed giving information about both the Applicant and the Joint Applicant or Other Person. Please mark Applicant-related information with an "A". If Section B was not completed, only give information about the Applicant in this Section. | ||
| ASSETS OWNED (Use separate sheet if necessary.) | ||
| DESCRIPTION OF ASSETS | NAME IN WHICH THE ACCOUNT IS CARRIED | VALUE |
| Checking Account Number (s) |
|
$
$ $ $ $ |
| TOTAL ASSETS: | $ | |
| OUTSTANDING DEBTS: (include charge accounts, installment contracts, credit cards, rent, mortgages and other obligations. (Use separate sheet if necessary.) |
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| CREDITOR | ACCOUNT NUMBER | NAME THE ACCT. IS UNDER | ORIGINAL AMT. | PRESENT BAL | MO. PMTS. |
| Landlord or Mortgage Holder |
Rent Payment Mortgage |
(OMIT RENT) $ |
(OMIT RENT) $ |
$ |
|
| Automobiles (make, model, year) |
$ | $ | $ | ||
| $ | $ | $ | |||
| $ | $ | $ | |||
| $ | $ | $ | |||
| $ | $ | $ | |||
| $ | $ | $ | |||
| $ | $ | $ | |||
| TOTAL DEBTS | $ | $ | $ | ||
| Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable): |
| Are you obligated to make Alimony, Support of Maintenance Payments? No Yes |
| If yes, to (Name & Address) Amt. Per Month $ |
| Are you a comaker, endorser, or guarantor on any loan or contract?
No
Yes If yes, for whom? To whom? |
| Are there any unsatisfied judgments against you?
No
Yes If yes, to whom owed? Amount: $ |
| Have you been declared bankrupt in the last 10 years? No Yes If yes, where? Year |
| Section E - Secured Credit | ||||
| Complete only if credit is to be secured. Briefly describe the property to be given as security and indicate if others have an ownership interest. | ||||
| Property description: |
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| Names & Addresses of all co-owners of the property: |
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| If the security is real estate, give the full name of your spouse (if any): | ||||
| Signatures - I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By signing below I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes. | ||||
| ____________________________________________ | __________________________________________________ | |||
| Applicants Signature | Other Signature (Where Applicable) and Date | |||
| ____________________________________________ | __________________________________________________ | |||
| Date | Date | |||