Big Country Autoland Credit Application

By submitting this form I authorize Big Country Autoland to check my credit and employment history and to provide and/or obtain information about credit experiences with me. I certify that the information is true and complete to the best of my knowledge. I further certify that I have attained the age of majority.

Personal Information

Primary or Joint Application: Primary Applicant Joint Applicant

If joint, relationship to applicant: Married Parent Other

Please provide the following contact information:

First name
Last name
Middle initial
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
E-mail

Please provide the following information:

Date of birth

Sex Male Female

Financial, Education & Employment Information

Mortgage information: Own home outright Buying home
Live with relatives Leasing / Renting Own / Buying mobile home

How long (yrs. & mos.) have you been at your present address?

Name and address of landlord or mortgage holder:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code

Previous address - if at current address less than 2 years:

Rent or mortgage payment:

Driver's License number and state:

Education Level: 4-year college grad 2-year college grad
high school grad special training

Current employer name:

Employer's City, State:

Your occupation:

Time on job (years, months):

Work phone number:

Gross Salary (amount Weekly, Yearly, or Monthly):

Social Security Number:

Other income:

Previous employers name (if less than 5 years with current):

Name of bank:

Banking Information: Checking and Savings
Checking Only Savings Only No account

Have you ever had a car or other mechandise repossessed: No Yes

If Yes, When:

Have you ever filed bankruptcy: No Yes
If Yes, When:

Are you obligated to make alimoney, child support,
or separate maintenance payments?

No Yes
If Yes, amount payed per month:

Creditor Information 1:

Name
City, State
Date Opened
Monthy Pmt.
Unpaid Balance

Creditor Information 2:

Name
City, State
Date Opened
Monthy Pmt.
Unpaid Balance

Creditor Information 3:

Name
City, State
Date Opened
Monthy Pmt.
Unpaid Balance

Creditor Information 4:

Name
City, State
Date Opened
Monthy Pmt.
Unpaid Balance

Nearest Relatives (not in household):

Name
Phone
Relationship

Name
Phone
Relationship

Name
Phone
Relationship