Centurion Federal Credit
2511 First Ave
P O Box 4486
Evansville, IN  47724-0486
How to Apply
This Credit Application may be filled out online and printed out with your information. 
Please complete red sections 1 through 8
Sign section 9
Return this application to the Credit Union
1  Note and Complete
Married Applicants may apply for separate account.  Check the appropriate box to indicate Individual Credit or Joint Credit.
Individual Credit:  Complete Applicant section.
Complete Co-Applicant, Spouse, Guarantor (referred to as "Other")section:
(1) about your spouse if you live in a community property state (AZ, CA, ID, LA, NM,  TX, WA, WI), or (2) if your spouse will use the Account, or (3) if there is a guarantor on this account.  Please check box to indicate whom the information is about.
Joint Credit:  Provide the information about both of you by completing Applicant and Other section.
Amount Requested  
Purpose  
Statement  of Intent
Credit Disability Insurance Single Credit Life Insurance Joint Credit Life
Check coverage(s) desired.  The credit union will disclose the cost of this voluntary insurance to you.  A separate insurance election which discloses the terms and conditions must be signed for coverage to become effective.
2  Applicant Information
Name (Last - First - Initial)
Driver License Number/State
 
Account Number                                                        Social Security Number
                            
Birth date                                           Home Phone                          Business Phone
Previous Address-Street                                         City                                            State     Zip
Own  Rent   Years at this address
Present Address-Street                                          City                                             State     Zip
Own  Rent      Years at this address
Complete for Joint Credit, Secured Credit or if you live in a community property state.
Married    Separated   Unmarried (Single-Divorced-Widowed)
List Ages of Dependents not listed by other applicant. 
Co Applicant  Spouse    Guarantor
Use "SSA" if "Same as Applicant"
Name (Last - First - Initial)
Driver License Number/State
 
Account Number                                                         Social Security Number
                            
Birth date                                      Home Phone                                Business Phone
Previous Address-Street                                        City                                             State    Zip
OwnRent Years at this address
Present Address-Street                                         City                                             State    Zip
Own  Rent   Years at this address
Complete for Joint Credit, Secured Credit or if you live in a community property state.
Married    Separated   Unmarried (Single-Divorced-Widowed)
List Ages of Dependents not listed by other applicant.
3  Employment Information
Applicant
Name and Address of Employer
Name                                           Street                                                    City                                                State     Zip
Your Title/Grade                         Supervisors Name                                        Start Date                                      Hours at Work
                    
If Self Employed, Type of Business
If Employed in Current Position Less Than Five Year, Complete Previous Employer Information
Name and Address of Previous Employer
Name                                           Street                                                   City                                                  State     Zip
Military - Is Duty Station Transfer Expected During The Next Year
Yes   No    Ending/Separation Date
Other (Co Applicant, Spouse, Guarantor)
Name and Address of Employer
Name                                           Street                                                    City                                                State     Zip
Your Title/Grade                         Supervisors Name                                        Start Date                                      Hours at Work
                    
If Self Employed, Type of Business
If Employed in Current Position Less Than Five Year, Complete Previous Employer Information
Name and Address of Previous Employer
Name                                           Street                                                   City                                                  State     Zip
Military - Is Duty Station Transfer Expected During The Next Year
Yes   No    Ending/Separation Date
4 References
Applicant
Name and Address and Telephone of Creditor(s) of Debts Paid Off
Name                                           Street                                                    City                                             State      Zip                     Telephone
Name and Address of Nearest Relative Not Living With You
Name                                           Street                                                    City                                             State      Zip                     Telephone
Name and Address of  A Personal Friend - Not a Relative
Name                                           Street                                                    City                                             State      Zip                     Telephone
Other (Co Applicant, Spouse, Guarantor)
Name and Address and Telephone of Creditor(s) of Debts Paid Off
Name                                           Street                                                    City                                             State      Zip                    Telephone
Name and Address of Nearest Relative Not Living With You
Name                                           Street                                                    City                                             State      Zip                     Telephone
Name and Address of  A Personal Friend - Not a Relative
Name                                           Street                                                    City                                             State      Zip                     Telephone
5 Income Information
Applicant
Notice:  Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income                                                            Other Income
$ Per        $ Per
Net    Gross                                                               Source
Other (Co Applicant, Spouse, Guarantor)
Notice:  Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.
Employment Income                                                            Other Income
$ Per        $ Per
Net    Gross                                                               Source
6 Assets
Applicant
Share Draft or Checking Amount
Name and Address of Depository
Savings Amount                        
Name and Address of Depository
List all assets and account number(s)-Attach other sheets if necessary.
Other (Co Applicant, Spouse, Guarantor)
Share Draft or Checking Amount
Name and Address of Depository
Savings Amount                        
Name and Address of Depository
7 Debts
In addition to Rent/Mortgage list all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilities, etc.)  Please use a separate line for each credit card and auto loan.  Attach other sheets if necessary.
Home  Rent  Own ( Include Taxes and Insurance)
Applicant    Other   Creditor Name and Address                                                          Account #         Original Bal      Present Bal     Monthly Pymt     Past due?
                      
Other Debts
Applicant    Other   Creditor Name and Address                                                          Account #         Original Bal      Present Bal     Monthly Pymt     Past due?
                      
Applicant    Other   Creditor Name and Address                                                          Account #         Original Bal      Present Bal     Monthly Pymt     Past due?
                      
Applicant    Other   Creditor Name and Address                                                          Account #         Original Bal      Present Bal     Monthly Pymt     Past due?
                      
Applicant    Other   Creditor Name and Address                                                          Account #         Original Bal      Present Bal     Monthly Pymt     Past due?
                      
Applicant    Other   Creditor Name and Address                                                          Account #         Original Bal      Present Bal     Monthly Pymt     Past due?
                      
Applicant    Other   Creditor Name and Address                                                          Account #         Original Bal      Present Bal     Monthly Pymt     Past due?
                      
8 Financial Information
These questions apply to both Applicant and Other
If  a "Yes" answer is given to a question, explain on an attached sheet.
                                                                                                                                            Applicant Other Yes No
Do you have any outstanding judgements?                                                                                                                                       
Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under Chapter 13?                                                       
Have you had property foreclosed upon or repossessed in the last 7 years?                                                                                          
Are you a party in a lawsuit?                                                                                                                                                           
Are you other than a U.S. citizen or permanent resident alien?                                                                                                            
Is you income likely decline in the next two years?                                                                                                                             
Are you a Co-Maker, Co-Signer or Gurantor on any loan not listed above?                                                                                          
9 Signatures
If there are any important changes, you will notify us in writing immediately.  You also agree to notify us of any change in your name, address or employment within a reasonable time thereafter.  You also promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is a complete listing of all your debts and obligations.  You authorize the credit union to obtain credit reports in connection with this application for credit and any update, renewal or extension of the credit received.  If you request, the credit union will tell you the name and address of any credit bureau from which it received a credit report on you.  You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to Federal Credit Unions or State Chartered Credit Unions insured by NCUA.
X_______________________________________ X_______________________________________
Applicants Signature                                    Date                                  Other  Signature                                    Date
Do not write in this section - for Credit Union Use Only
__________ Approved Limits$_______________$ _______________$ _______________$ _______________$ _______________
Date                                          Signature                   Line of Credit           Other                        Other                        Debt Ratio
Loan Office                Advanced Approved Yes No    Counter Offer will be made, if accepted advance approved
Credit Committee or Other      Outside Information Considered  Yes  No  If yes, attach additional sheets and describe
Referred To/Reason(s) for Referral:
Describe Counter Offer:
________________________________________________________________________________
Reason(s) for Rejection:
__________________________________________________________________________________________________________
Signatures:
Loan Officer  X_______________________________Date_________ X________________________________Date________
Credit Committee X___________________________Date_________X________________________________Date________
ECOA Notice and Reason for Rejection Sent or Delivered on______________Date__________________By______Initials