Landmark-Chevrolet-Buick-Cadillac

1531 West Springfield Rd.
Taylorville, IL 62568
Phone: 217-824-2255
Fax: 217-824-8097

Custom Finance Manager

Contact: Lorie Morris Phone: (217) 824-2255 Toll Free: 866-472-6822

Email: Lorie Morris

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This secure form will start the credit verification process. Fields marked * are required.

Applicant Information

First Name *

Middle Initial

Last Name *

Suffix

Date of Birth (dd/mm/yyyy) *

Email *

Social Security Number *

Address *

City *

State *

ZIP *

Home Phone *

Housing Information

Length of Residence *

Housing Status *

Mortgage/Rent Amount *

Landlord or Mortgage Holder *

Previous Address *

Previous City *

Previous State *

Previous ZIP *

Previous Length of Residence *

Employment Information

Employer *

Occupation *

Employer Phone *

Additional Income, Child Support, etc.

Gross Monthly Income *

Time Employed *

Previous Employer *

Previous Occupation *

Previous Time Employed *

Previous Employer's Phone

Contacts

Relative (Not Living With You)

Relative Phone Number

Personal Friends Name

Friends Phone Number

Relative Address

Friends Address

Your Current Auto Loan

Make/Model

Signature & Privacy Statement

Signature *

Date (dd/mm/yyyy) *

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