Visa Credit Card Application

REQUESTED CREDIT LIMIT $
Credit Limit Requests over $10,000, Self Employed Applicants, and/or Business Accounts require a current Financial Statement and copy of recent tax return.

IMPORTANT! Please read these directions before completing this application.
You may apply for this account in your name alone, or with any other person. If you are applying jointly, one should apply as applicant and the other as co-applicant. If there is a co-applicant, both must sign the application. NOTICE: You need not disclose Other Income derived from alimony, child support, or separate maintenance payments unless you wish to use such to establish your credit worthiness. If you rely on Other Income, information about your spouse or former spouse may be required.

APPLICANT INFORMATION: Please provide all requested information. Incomplete applications cannot be processed.

Name (First Name Initial Last Name):
Social Security Number:
Date of Birth:
Cell Phone Number:	( Cell Phone Number: Area Code ) Cell Phone Number: Prefix - Cell Phone Number: Line Number
Current STREET Address (No P.O. Boxes):
Apt No.
City, State:	,
Zip:	- Zip plus 4 (optional)
Home Phone Number:	( Home Phone Number: Area Code ) Home Phone Number: Prefix - Home Phone Number: Line Number
Number of Dependents:
Do you:	Rent Own Live with Parents Other
Monthly Payment: $
Email Address:
Mother's maiden name:
Security Password:
Current Employer:
Employer Address:
City, State:	,
Zip:	- Zip plus 4 (optional)
Employer Telephone Number:	( Employer Telephone Number: Area Code ) Employer Telephone Number: Prefix - Employer Telephone Number: Line Number
Year/Months:
Position Held:
Gross Monthly Salary: $
Former Employer and Position:
Years/Months:
Nearest Relative NOT Living With You	Nearest Relative NOT Living With You: First Name Nearest Relative NOT Living With You: Last Name
Relationship:
Address of Relative:
Phone Number of Relative:	Phone Number of Relative: Area Code Phone Number of Relative: Prefix Phone Number of Relative: Suffix

OTHER INCOME: (Alimony, child support, or separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation)

Source of Other Income:
Monthly Amount: $
Alimony, Child Support, Separate maintenance received under:	Court Order Written Agreement Oral Understanding

GENERAL INFORMATION

Are you a permanent resident of the U.S.?	Yes No
Have you ever obtained credit under another name?	Yes What Name? No
Have you ever declared Bankruptcy?	Yes What Year? No

Co-Applicant Information Please provide all requested information. Incomplete applications cannot be processed.

First Name
Initial:
Last Name:
Social Security Number:
Date of Birth (mm/dd/yyyy):
Cell Phone Number:	( Cell Phone Number: Area Code ) Cell Phone Number: Prefix - Cell Phone Number: Line Number
Current STREET Address (No P.O. Boxes):
Apt No.:
City, State:	,
Zip:
Home Phone Number:	( Home Phone Number: Area Code ) Home Phone Number: Prefix - Home Phone Number: Line Number
Number of Dependents:
Do you:	Rent Own Live with Parents Other
Monthly Payment: $
Email Address:
Mother's maiden name:
Security Password:
Current Employer:
Employer Address:
City, State:	,
Zip:	- Zip plus 4 (optional)
Employer Telephone Number:	( Employer Telephone Number: Area Code ) Employer Telephone Number: Prefix - Employer Telephone Number: Line Number
Year/Months:
Position Held:
Gross Monthly Salary: $
Former Employer and Position:
Years/Months:
Nearest Relative NOT Living With You	Nearest Relative NOT Living With You: First Name Nearest Relative NOT Living With You: Last Name
Relationship:
Address of Relative:
Phone Number of Relative:	Phone Number of Relative: Area Code Phone Number of Relative: Prefix Phone Number of Relative: Line Number

CO-APPLICANT OTHER INCOME: (Alimony, child support, or separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation)

Source of Other Income:
Monthly Amount: $
Alimony, Child Support, Separate maintenance received under:	Court Order Written Agreement Oral Understanding

GENERAL INFORMATION

Are you a permanent resident of the U.S.?	Yes No
Have you ever obtained credit under another name?	Yes What Name? No
Have you ever declared Bankruptcy?	Yes What Year? No

DISCLOSURE OF TERMS INTEREST RATES AND INTEREST CHARGES
ANNUAL PERCENTAGE RATE (APR) For Purchases, Cash Advances and Balance Transfers	10.95% or 14.95% Fixed Card designation and Associated Rate is based on credit worthiness and underwriting criteria.
Penalty APR and When it Applies	21% Explanation of Penalty Rate: If a Visa Account reaches 60 days past due: The APR will increase to 21% for purchases, cash advances and balance transfers Account will be closed and no longer available for use Cardholder will still be responsible for any outstanding balance on account by making the required minimum payment Any Rewards points earned will be forfeited upon account closure The account will remain at the higher rate until Six consecutive minimum payments have been received on the account
Balance Calculation Method for Purchases & Cash Advances	The average daily balance is computed by adding together the daily outstanding balances and new purchases on each day of the billing cycle and dividing the resulting sum by the number of days in the billing cycle. Advances and advance transaction fees for the current billing period, annual fees, currency conversion fees, late charges, returned payments fees, and finance charges, if any, will not be included in the Average Daily Balance calculation. The finance charge is calculated by adding any transaction charges imposed on new cash advances to the amount determined by applying a monthly periodic rate to the above described average daily balance.
Minimum Finance Charge for Purchases & Cash Advances	$.50 (Unless Purchase Average Daily Balance is Zero)
How to Avoid Paying Interest on Purchases: Grace Period for Repayment of Balance for Purchases	You must pay the entire "New Balance" in full, shown on your monthly statement on or before the Payment Due Date. You have 25 Days Grace period for repayment of balances for purchases and cash advances, calculated from the statement closing date to the payment due date.
For Credit Card Tips from the Consumer Financial Protection Bureau	To learn more about factors to consider when applying for or using a credit card, visit the website of the Consumer Financial Protection Bureau at http://www.consumerfinance.gov/learnmore
FEES
Annual Fee	NO ANNUAL FEE
Transaction Fees Cash Advance Foreign Transaction Balance Transfer	Either $5.00 or 2.5% of amount advanced, whichever is greater 1% of the Foreign Country Transaction NO BALANCE TRANSFER FEE
Penalty Fees Late Payment Over-the-Credit Limit Returned Payment	Up to $30.00 NO OVER-LIMIT FEES $25.00
Business CB Rewards Annual Fee (For Business Accounts Only)	Up to $50.00
Other Fees	Copy of transaction $20.00 per copy; copy of statement $5.00 per additional copy; research fee $25.00 per hour; additional plastic $2.50 per card; year-end statement fee $5.00
SIGNATURES By signing below, I (each Applicant and any Co-Applicant) hereby: (1) agree to the Terms and Conditions as specified in the Cardholder Agreement; (2) understand that will be jointly and severally liable with each other applicant for all obligations; (3) certify that all of the information I have provided on this application is true, correct, and complete; (4) authorize Central Bank to gather whatever credit information you consider necessary and appropriate, including consumer reporting agencies; (5) If the requested card is granted, I authorize you to give such information to others who have a legitimate reason for the information. I also authorize Central Bank to contact me on any phone number(s) provided currently or hereafter acquired, for any banking business concerning my accounts. This applies to accounts I now have or hereafter are added. I understand and agree that such phone calls and texts may be delivered using an automatic telephone dialing system as well as an artificial or prerecorded voice. I understand and agree that I am not required to consent to be contacted as a condition to receive any product or service.
Sign APPLICANT'S SIGNATURE
DATE
Sign CO-APPLICANT'S SIGNATURE
DATE
Visa Terms and Conditions are accurate as of the printing date of 11/17. Visa Terms and Conditions are subject to change upon 45 day prior notification to Cardholder. Cardholder may contact Central Bank, 75 N. University Ave., Provo, UT 84601 or call 801-375-1000 regarding any information disclosed. THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT PROHIBITS CREDITORS FROM DISCRIMINATING AGAINST CREDIT APPLICANTS ON THE BASIS OF SEX OR MARITAL STATUS. THE FEDERAL AGENCY WHICH ADMINISTERS COMPLIANCE WITH THE LAW CONCERNING THIS ACT IS THE FDIC, 25 ECKER ST, SUITE 2300, SAN FRANCISCO, CA 94105.

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