*Name:
Street Address:
City:
State:
Zip:
*Email Address:
Home Phone:
-
Work Phone:
-
Contact Time:
[Choose]
In the Morning
In the Evening
In the Afternoon
Birth Date:
MM
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2
3
4
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7
8
9
10
11
12
/
DD
1
2
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/
Social Security Number:
Bankruptcy in past 7 years:
Yes
No
Cosigner Available:
Yes
No
Residence Stability:
[Choose]
Live w/Others
Live w/Parents
Renting
Leasing
Owner/Buyer
Residence Changes Last 2 Years:
[Choose]
4 Residence Changes
3 Residence Changes
2 Residence Changes
1 Residence Change
No Residence Change
Time in Area:
[Choose]
0-12 Months
1-5 Years
5-10 Years
10-25 Years
Over 25 years
Phone Type:
[Choose]
No Phone
Non Relatives
Relatives
Spouses
Own
Time on Job:
[Choose]
0-6 Months
7-12 Months
13-35 Months
3-5 Years
Over 5 Years
Full-time Job Changes Last 2 Years:
[Choose]
4 Job Changes
3 Job Changes
2 Job Changes
1 Job Change
No Job Change
Monthly Gross Income:
[Choose]
$500-$1,374
$1,375-$1,724
$1,725-$2,299
$2,300-$2,999
Over $3,000
Down Payment:
[Choose]
$500
$500-$1,000
$1,000-$2,000
Over $2,000
ACKNOWLEDGMENT AND CONSENT: I certify that the above information is complete and accurate to the best of my knowledge. I understand that false statements may subject me to criminal penalties. By clicking "Submit Credit Application" I authorize Landis Corvettes and More and/or its lenders to obtain my credit report and to review and verify my application information. I agree to inform Landis Corvettes and More prior to funding of any changes in the information provided above.