GENERAL INFORMATION(salesman will fill in this part)
Salesperson: __________________________________________________ Date:_______________ Individual or Joint Credit:_____________________ Harley-Davidson® Dealer:_________________________ Dealer # _________ Purpose of Loan? ___ New ___ Used ______________________________ Amount Down: ______________Year: _____ Model: __________________
Selling Price: $ _________________ Additional Services: $ ____________ Accessories: $ _________________ Taxes: $ ______________________	Extended Warranty: $ ____________ Insurance: $ ___________________ Other: $ ______________________ Total Cash Price: $ ______________

PLEASE TELL US ABOUT YOURSELF(start here)

Print your full name (First, Middle Initial, Last) ____________________________________________________________ Social Security # _________________ Date of Birth __________________ Age ________ Number of Dependents _____________________________ Street Address (no P.O. Boxes)______________________________________ City ________________ State __________ Zip Code _________________ How Long ______ Home Phone _____________ Own or Rent __________ Name of Landlord or Lender _____________________________________ Account # _______________ Monthly Payment or Rent ______________ Mortgage Balance __________ Present Market Value of Home: _____________ Equity: _______________ Is there a second mortgage or home equity loan? Yes _______ No ________ Payment: _________________ Balance: ___________________________ Previous Address ____________________________ How Long _________ City ______________________ State _________ Zip Code ____________ Current Employer ______________________________________________ Position_______________________________ How Long ______________ Employer's Address ____________________________________________ Phone _________________ Supervisor's Name: _____________________ Gross Income per Month _____________ per Year ___________________ Previous Employer ______________________________________________ Phone # ______________________________ How Long ______________ Type of Other Income* _________________________________________ Source __________________________ Monthly amount ______________ Have you ever filed for backruptcy or been declared insolvent? Yes _______ No _______ Marital Status ____________________ Name of Nearest Relative Not Living With You ______________________ Address _____________________________________________________ Phone ________________________ Relationship ____________________ Name of Personal Friend ________________________________________ Address _____________________________________________________ Phone __________________________ How Long ___________________

JOINT APPLICATION INFORMATION

Joint Applicant (J/A) full name: (First, Middle Initial, Last) _____________________________________________________________ Phone ____________________________ Relationship _________________ Date of Birth ___________________ Social Security # _________________ J/A Home Address ______________________________________________ J/A Employer _________________________ Position _________________ Joint Applicant Income _____________________ How Long ____________ Employer's Address __________________________ Phone _____________

CREDIT REFERENCE

Name of Bank _________________________________________________ Checking Account #__________________________ Name of Bank _________________________________________________ Savings Account #___________________________ Last Motor Vehicle Financed: _____________________________________ Name of Creditor: ______________________________________________ Payments: _____________ (per month) Balance remaining: _____________

OTHER OUTSTANDING OBLIGATIONS

Name of Creditor/Obligation ______________________________________ Description ___________________________________________________ _______________________________________ Account # _____________ Name of Creditor/Obligation ______________________________________ Description ___________________________________________________ _______________________________________ Account # _____________ Name of Creditor/Obligation ______________________________________ Description ___________________________________________________ _______________________________________ Account # _____________

* Alimony, child support or separate maintenance income need not be revealed if you do not wish it to be considered as a basis of repayment. ___________________________________________ DATE: ___________ APPLICANT SIGNATURE ___________________________________________ DATE: ___________ JOINT APPLICANT SIGNATURE