Credit Application

Good credit, bad credit, or no credit at all — we can help! At Roughlock Auto, we partner with a wide range of lenders to offer flexible financing and payment options for every credit situation. You could be approved in minutes. Start by completing our quick online form or schedule an appointment to speak with one of our team 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