Credit Application

5942 Whitmore Lake Road
Brighton, MI 48103
Credit Application
Items with an asters * are required.

Applicant

First Name*:

Last*:

Middle Name*:

Address*:

City*:

State/Province*:

ZIP*:

County:

Home Phone*:

Social Security No*:

Drivers License
Number*:

Date of Birth*:

Number of
Dependents:

Previous Address:
(If less than 2 years at present:)

Years at Current
Address*:

Nearest Relative*:
(Not living in household)
Relationship to
Applicant*:

E-Mail Address*:

Applicant Employment

Present Employer Name and Address*:

Employer Phone No*:

Occupation*:
(Job Title)

Years of Service*:

Gross Salary
$ Per Month*:

Supervisors Name:

Alimony, child support, or separate maintained income need not be revealed if you do now wish to have it considered as a basis of repaying this obligation.

Other Monthly Income:

Source:

Previous Employment:

Years of Service:

Co-Applicant

First Name:

Last:

Middle Name:

Address:

City:

State/Province:

ZIP:

County:

Years at Current Address:

Drivers License
Number:

Home Phone:

Date of Birth:

Social Security No:

Number of
Dependents:

Co-Applicant Employment

Present Employer Name and Address:

Employer Phone No:

Occupation:
(Job Title)

Years of Service:

Gross Salary
Per Month:

Credit References

Bank, Credit Union or Savings & Loan Account:

Branch Address:

Type of Account:
Savings
Checking

Residence*:
Own    Rent    Other    Mobile Home    Live with Parents /Relative

Name & Address
of mortgage co
or landlord*:
Monthly Payments*:

Name of Creditor:
Applicant Co-Applicant

Open
Closed Open
Closed

Open
Closed Open
Closed

Open
Closed Open
Closed

Open
Closed Open
Closed

Has any of your property ever been repossessed*?
No
Yes      When?

Are there any unsatisfied judgments against you*?
No
Yes

Have you ever been personally involved in a bankruptcy proceeding*?
No
Yes

Are you endorser or guarantor on any other loans or contracts*?
No
Yes

References*
Name: Address: Phone No.:

Transaction*
Motorcycle

New    Used
Year: Model: Make:

$ Down Payment:

Trade-In:
Yes    No

Trade-In $:

Everything I have stated in this application is true to the best of my knowledge, and Is an accurate statement of my obligations and the income upon which I will rely to pay the credit requested. I understand that you will rely on this information in deciding whether or not to grant or continue credit to me. I also understand that you will retain this information whether or not my application is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me.

Comments:

Items with an asters * are required.

After filling out the form, click the following
"Submit Comments" button ONCE, then please wait for a reply.



Subject to change without notice.
(c) 1996 Brighton Harley-Davidson & Buell Shop. All rights reserved.


Applicant
First Name*:		Last*:
Middle Name*:
Address*:		City*:
State/Province*:		ZIP*:
County:		Home Phone*:
Social Security No*:		Drivers License Number*:
Date of Birth*:		Number of Dependents:
Previous Address: (If less than 2 years at present:)		Years at Current Address*:
Nearest Relative*: (Not living in household)		Relationship to Applicant*:
E-Mail Address*:

Applicant Employment
Present Employer Name and Address*:
Employer Phone No*:		Occupation*: (Job Title)
Years of Service*:		Gross Salary $ Per Month*:
Supervisors Name:
Alimony, child support, or separate maintained income need not be revealed if you do now wish to have it considered as a basis of repaying this obligation.
Other Monthly Income:		Source:
Previous Employment:		Years of Service:

Co-Applicant
First Name:		Last:
Middle Name:
Address:		City:
State/Province:		ZIP:
County:
Years at Current Address:		Drivers License Number:
Home Phone:		Date of Birth:
Social Security No:		Number of Dependents:

Co-Applicant Employment
Present Employer Name and Address:
Employer Phone No:		Occupation: (Job Title)
Years of Service:		Gross Salary Per Month:

Credit References
Bank, Credit Union or Savings & Loan Account:
Branch Address:		Type of Account:	Savings Checking
Residence*: Own Rent Other Mobile Home Live with Parents /Relative
Name & Address of mortgage co or landlord*:			Monthly Payments*:
Name of Creditor:		Applicant	Co-Applicant
		Open Closed	Open Closed
		Open Closed	Open Closed
		Open Closed	Open Closed
		Open Closed	Open Closed
Has any of your property ever been repossessed*?		No Yes When?
Are there any unsatisfied judgments against you*?		No Yes
Have you ever been personally involved in a bankruptcy proceeding*?		No Yes
Are you endorser or guarantor on any other loans or contracts*?		No Yes
References* Name:	Address:		Phone No.:



Transaction* Motorcycle
New Used	Year:	Model:	Make:
$ Down Payment:		Trade-In: Yes No	Trade-In $:

Everything I have stated in this application is true to the best of my knowledge, and Is an accurate statement of my obligations and the income upon which I will rely to pay the credit requested. I understand that you will rely on this information in deciding whether or not to grant or continue credit to me. I also understand that you will retain this information whether or not my application is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. Comments:

Items with an asters * are required. After filling out the form, click the following "Submit Comments" button ONCE, then please wait for a reply.