Landmark Ford

2401 Prairie Crossing Dr.
Springfield, IL 62711
Phone: 866-430-5509
Fax: 217-522-4639

Credit Application

* Required

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 *

* Required

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.