Harley-Davidson Credit
Online Credit Application ( Revised 6-1-08 )

Date:
Email
Full Name
Social Security No.
Date of Birth
Drivers License Number
Number of Dependents:
Address
Address (cont.)
City
State
Zip Code
How long have you lived at this address?	Years: Months:
Home Phone
Preferred Contact Phone
Do you	own  rent  other
Landlord or Lender
Account No
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
City
State
ZIP
How Long?
Current Employer
Position
How Long?
Employer's Address
Employer's Phone No.
Supervisor's Name
Gross Income	per month  per year
Previous Employer
Phone No
How Long?
Type of Other Income if Applicable*
Source
Monthly Amount
* Alimony, Child Support, and/or Separate Maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Name and Address of Nearest Relative Not Living With You:
Name
Address
City
State
ZIP
Phone
Relationship
Name and Address of Personal Friend:
Name
Address
City
State
ZIP
Phone
Known how long?
Marital Status	Married  Unmarried
Have you ever filed a bankruptcy or been declared insolvent:
Yes	If so, when?
No
JOINT APPLICATION INFORMATION:
Joint applicant  (J/A) info:
(J/A) Name
(J/A) Phone No.
Relationship to Primary Applicant
Date of Birth
Social Security No.
(J/A) Home Address
Gross Income per mon.
(J/A) Employer
(J/A) Position
How Long?
Employer's Address
Employer's Phone No.
Name and Address of Nearest Realtive Not Living With You:
Name
Address
City
State
ZIP
Phone
Relationship
Name and Address of Personal Friend:
Name
Address
City
State
ZIP
Known how long?
CREDIT REFERENCES
Checking Account No.
Name of Bank
Savings Account No.
Name of Bank
Last Motor Vehicle Financed:
Name of Creditor:
Balance Remaining:
Payments per month:
OTHER OUTSTANDING OBLIGATIONS
(1) Name of Creditor or Obligation:
Description
Account No.
(2) Name of Creditor
Description
Account No.