Pre-OwnedPowersports - Credit Application

Directions

Applicant(s) must read these directions before completing this application.

Provide all information requested. Failure to provide complete information as request in this credit application my dealy review of your credit application.

This form is secure to protect your information.

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 to you - When you open a credit account 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 drivers license or other identifying documents.

Where is the motorcycle you are applying for located? Or which store do you prefer to apply for? * Stubbs Cycles (4400 Telephone Road)Stubbs 59 Powersports (10430 Southwest Frwy)San Jacinto HD (3636 E. Sam Houston Pkwy South)

Select the appropriate option * You are applying as for INDIVIDUAL credit in your own name and you are not relying on the creditworthiness of another person as the basis for repayment fo the credit requested.You are applying for JOINT credit with another person.You are applying with a COSIGNER to support the credit requested.

What bike are you applying for credit for?

Applicant Information

Applicant Full Name

Social Security Number

Date of Birth

*Applicants must be at least 18 years old.

Driver's License Number

Current Physical Address

Street Address

Address continued

City

State

Zip

County

Mailing address is same as Physical address YesNo

Mailing Address

Street Address

Address continued

City

State

Zip

How long have you lived at this location?

OwnRentOther

Monthly Housing Payment

Primary Phone Number

( )

-

Applicant Email

Current Employer

Employer Name

Employer City

Employment State

Business Phone Number

Years/Months There

Gross Income

Income Frequency

Other Income*

* Alimony, Child Support, and/or Separate Maintenance income need not be revealed if you do not wish to have it considered asa basis for repaying this obligation.

Other Income Frequency

Joint / Cosigner Information

Joint / Cosigner Full Name

Social Security Number

Date of Birth

*Applicants must be at least 18 years old.

Driver's License Number

Current Physical Address

Street Address

Address continued

City

State

Zip

County

Mailing address is same as Physical address YesNo

Mailing Address

Street Address

Address continued

City

State

Zip

How long have you lived at this location?

OwnRentOther

Monthly Housing Payment

Primary Phone Number

( )

-

Joint / Cosigner Email

Current Employer

Employer Name

Employer City

Employment State

Business Phone Number

Years/Months There

Gross Income

Income Frequency

Other Income*

* Alimony, Child Support, and/or Separate Maintenance income need not be revealed if you do not wish to have it considered asa basis for repaying this obligation.

Other Income Frequency

References

Name

Phone Number

City

State

Name

Phone Number

City

State

Name

Phone Number

City

State

Name

Phone Number

City

State

Submit

I understand that any credit insurance products and GAP (where applicable) are not deposits or other obligations of, or guaranteed or insured by, Eaglemark Savings Bank (ESB) or its affiliates. I understand that these products and debt protection are not insured by the Federal Deposit Insurance Corporation (FDIC) or any other agency of the United States; and

I understand that I am free to purchase credit insurance products and GAP (where applicable) from another source, and that ESB does not condition credit on whether these products are purchased from ESB or its affiliates, and ESB does not require me to agree not to obtain these products from another source; and

I have the directions of this form and I agree to the terms and conditions set forth in this Credit Application; and

I hereby authorize an investigation of my credit and employment history by ESB or its designees. I understand that my credit and employment history obtained in, and in connection with, this Credit Application will be used in determining my eligibility for credit approval by ESB, and its successors and assigns, may obtain credit information about me on an ongoing basis in connection with this extension of credit transaction for any one or more of the following reasons: (1) reviewing the account; (2) taking collection action on the account; or (3) any other legitimate purposes associated with the account.

I understand and agree to the above.

I want an insurance quote/estimate at this time. I hereby authorize an investigation of my credit, driving and claims history by Harley-Davidson Insurance Services (HDIS) and unaffiliated insurance carriers. By checking this box, I acknowledge that I am not opting-in for Privacy Policy purposes.

I want an insurance quote.

By Submitting this application I hereby certify that the information I have provided in this Credit Application is complete and accurate to the best of my knowledge.