Single Credit Application

Thank you for taking the time to fill out a credit application for Ruxer Ford Lincoln. Be assured that the information you submit is kept secure and confidential.

Note: * Indicates a required field.


Preferred Salesman:
Primary Applicant: Personal Information
First Name: *
Middle Initial: *
Last Name: *
Address: *
City: *
State: *
Zip: *
Time at Residence:*
Years: Months:
Phone: *
E-mail: *
Date of Birth: *
Month: Day: Year:
Social Security Number: *
Driver’s License Number: *
Dwelling Information
Please Check Oneof the Following: *
  • Own Home Outright
  • Buying Home
  • Living with Relatives
  • Leasing/Renting
  • Own/Buying Mobile Home
Name of Landlord orMortgage Holder: *
Address of Landlord orMortgage Holder: *
Rent or MortgagePayment: * $
Employer Information
Your Current Employer:
Employer Phone:
Your Position:
Time on Job:
Years: Months:
Gross Annual Income: $ Before Taxes
Other Income: $
Have You Ever Had a Car or Other Merchandise Repossessed? * Yes No
If Yes, Date of Repossession:
Have You Ever Had a Bankruptcy? Yes No
Fair Credit Reporting Act Disclosure
Privacy Notice
By clicking Submit you agree to the above statement and allow Ruxer Ford Lincoln to check your credit. If you choose not to please click on No Thanks.
Security code: CAPTCHA Image
Reload Image
Verify code: *