Forward to your local Harley-Davidson® dealer for submission to Eaglemark Savings Bank.
Dealer Completes This Section
Page 1 of 2
A subsidiary of Harley-Davidson Credit Corp.
Less Down Payment
Less Net Trade-In
Secondary Asset (e.g., sidecar, engine, trailer)
IMPORTANT: APPLICANT(S) MUST READ THESE DIRECTIONS BEFORE COMPLETING THIS APPLICATION
❏ If you are applying for INDIVIDUAL credit in your own name, and you are not relying on the creditworthiness of another person as the basis for repayment of the credit requested,
Complete the Applicant Information section.
❏ If you are applying for JOINT credit with another person, Complete both Applicant Information and Joint/Cosigner Applicant Information sections.
We intend to apply for joint credit: Applicant X___________________________________ Joint Applicant X___________________________________
❏ If a COSIGNER’S information will be submitted to support the credit requested, Complete both Applicant Information and Joint/Cosigner Applicant Information sections.
Applicant Information Applicant(s) must be at least 18 years old.
Notice to Applicant(s) – Print clearly. Use dark ink. Provide all information requested. Failure to provide legible and complete information as requested in this credit application may delay
review of your credit application.
Applicant Full Name
Social Security Number (9 digits)
Date of Birth (mm/dd/yyyy)
Driver’s License Number
Current Physical Address
How Long Have You Lived There
Monthly Residence Payment
Home/Cell Phone Number (w/Area Code)
❏ Mailing Address (check box if same as physical address)
Current Employer Employment Status: ❏ Employed ❏ Self Employed ❏ Retired ❏ Disability ❏ Social Security ❏ Rental ❏ Court Order ❏ Investment ❏ Unemployed
Other Income Frequency