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Credit Application

FINANCING

Applicant Information:
Applicant Full Name:
Social Security Number:
Date of Birth:

Current Mailing Address:
Address:
City:
State:
Zip:
Home Phone Number:
How long have you lived there?:
Monthly housing payments:
	Own Rent Other

Physical Address ( if different from current mailing address ):
Address:
City:
State:
Zip:

Previous Address ( if less than 2 years at current address ):
Address:
City:
State:
Zip:
How long did you live there?:

Current Employer
Name:
Work Phone:
Gross Income per Month:
Position:
How Long Have You Worked There?:
Other Income Source:
Other Income Amount:

Previous Employer ( if less than 2 years at current employer )
Name:
How Long Did You Work There?:

Joint / Co-Signer Applicant Information
Joint / Co-Signer Applicant Full Name:
Relationship:
SS Number:
Date of Birth:

Current Mailing Address
Address:
City:
State:
Zip:
Home Phone Number:
How long have you lived there?:
Monthly housing payments:
	Own Rent Other

Current Employer
Name:
Work Phone:
Gross Income per Month:
Position:
How Long Have You Worked There?:
Other Income Source:
Other Income Amount:

References
1. Relationship:
Name:
Home Phone Number:
City:
State:

2. Relationship:
Name:
Home Phone Number:
City:
State:

NOTICE TO APPLICANT(S)

Provide all information requested.

If you fail to provide your NAME, ADDRESS, AND SOCIAL SECURITY NUMBER, this communication will be the only notice to you that your application is an incomplete application and that it will be given no further consideration.

Important Information About Procedures for Opening a Credit Account with Eaglemark Savings Bank*

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open a credit account with Eaglemark Savings Bank, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

* A member of the Harley-Davidson Financial Services family

NOTICE TO APPLICANT(S)

This Credit Application - Customer Statement will be submitted to Eaglemark Savings Bank, and its successors and assigns, at 4150 Technology Way, Carson City, Nevada 89706, for consideration of whether it meets the credit requirements of Eaglemark Savings Bank, and its successors and assigns. Applicant will be required to obtain and pay for vehicle insurance covering the collateral for the full term of the loan, for liability and physical damage for both collision and comprehensive losses to include such perils as FIRE, THEFT, and VANDALISM. Eaglemark Savings Bank, and its successors and assigns, must be listed as a LOSS PAYEE AND ADDITIONAL INSURED.

Applicant will provide verification in the form of a certificate of insurance through an acceptable carrier with thirty (30) days notice of any intent to cancel or non-renew to be provided by the issuing carrier to the applicant and loss payee. YOU MAY CHOOSE THE PERSON THROUGH WHOM ANY INSURANCE IS OBTAINED. Applicant(s) must be at least 18 years old.

NOTICE TO CALIFORNIA RESIDENTS: Regardless of your marital status, you may apply for credit in your name alone.

NOTICE TO MAINE RESIDENTS: Consumer reports (credit reports) may be requested in connection with this application. Upon request, you will be informed whether or not a consumer report was requested and, if it was, of the name and address of the consumer reporting agency that furnished the report.

NOTICE TO NEW YORK RESIDENTS: Consumer reports may be requested in connection with the processing of your application and any resulting account. Upon request, we will inform you of the names and addresses of any consumer reporting agencies which have provided us with such reports.

NOTICE TO OHIO RESIDENTS: Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

NOTICE TO RHODE ISLAND RESIDENTS: Consumer reports may be requested in connection with this application.

NOTICE TO MARRIED WISCONSIN RESIDENTS: No provision of a marital property agreement, a unilateral statement under Wisconsin Statutes 766.59 or a court decree under Wisconsin Statutes 766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.