Landmark-Chevrolet-Buick-Cadillac

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

Credit Application

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This secure form will start the credit verification process.

Applicant Information

First Name *

Middle Initial

Last Name *

Suffix

Date of Birth *

Social Security Number *

Email *

Home Phone *

Work Phone *

Cell Phone

Address *

City *

State *

ZIP *

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

Previous Rent or Mortgage Amount

Employment Information

Employer *

Occupation

Employer Phone *

Gross Monthly Income *

Time Employed

Previous Employer

Previous Occupation

Previous Employer's Phone

Previous Gross Monthly Income

Previous Time Employed

Your Current Auto Loan

Make/Model

Signature & Privacy Statement

Signature *

Date *

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By submitting this credit application, I verify that the information provided is complete and accurate to the best of my knowledge. I further authorize an investigation of my credit and employment history. I also accept the terms of the Privacy Policy.