Mid-State Chevrolet Buick

2040 Sutton Lane
Sutton, WV 26601
Phone: 304-765-3988
Fax: 304-765-5269

Credit Application

Sales: 866-212-1064
Service: 304-765-5016

* Required

This secure form will start the credit verification process.

Applicant Information

First Name *

Middle Initial *

Last Name *

Suffix

Date of Birth *

Social Security Number *

Email *

Address *

City *

State *

ZIP *

Phone Number *

Spouse's First Name

Spouse's Last Name

Spouses Date of Birth

Spouses SSN

Housing Information

Length of Residence *

Housing Status *

Mortgage/Rent Amount *

Landlord or Mortgage Holder *

Previous Address *

Previous City *

Previous State *

Previous ZIP *

Previous Length of Residence *

Previous Rent or Mortgage Amount *

Employment Information

Employer *

Occupation *

Employer Phone *

Gross Monthly Income *

Time Employed *

Previous Employer *

Previous Occupation *

Previous Employer's Phone

Previous Gross Monthly Income *

Previous Time Employed *

Spouses Occupation

Spouses Current Employer

Spouses Employer Phone

Spouses Gross Monthly Income

Your Current Auto Loan

Make/Model

Signature & Privacy Statement

Signature *

Spouses Signature

Date *

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