Credit Application

Good credit, bad credit, no credit - no problem! At Roughlock Auto, we work with a variety of lenders offering flexible financing and payment options for all credit types. You could be approved in minutes! Fill out our online application or stop by to talk to one of our staff members today.

Personal Information

First Name

Middle Initial

Last Name

Date of Birth

Social Security#

Home Phone

Work Phone

Street Address

City

State

Zip

Income Level

Additional Monthly Income

Number of Dependents

Ages of Dependents

Time at Address

Own or Rent

Mortgage Holder or Landlord

Mortgage Payment or Rent Per Month($)

Previous Address

Employer

Occupation

Date Employed

Previous Employer

Previous Employment Status

Previous Employment Time

Co-Applicant Personal Info