Allow us to help you with the financing of your new motorcycle. Please complete the form with the most information possible.

SECTION ONE . . . . . . . . . . . . . APPLICANT INFORMATION:

E-mail Address:
Bike Interest:
Full Name:
Social Insurance #:
Drivers License #:
Date of Birth: (mm/dd/yyyy)
Current Address:
City or Town:

Province/Territory:
Postal Code:
Home Phone:
Time at Current Address:
Monthly Rent/Mortgage Cost:
Do you Own, Rent or Other?
 Own Rent Other
Previous Address
(if less than 2 years at current address)
City or Town:
Province/Territory:
Postal Code:
How Long did you live there?
Employment:
 Current Employer:
or Self Employed
Work Phone:
Gross Monthly Income:
Position:
How long have you worked here?
Other Income Source (**):
Other Income 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.
Previous Employer:
(if less than 2 years with current employer)
How long did you work there?

SECTION TWO . . . JOINT APPLICANT (CO-SIGNER) INFORMATION (if applicable)

* If you don't want a co-signer, then please feel free to skip this section. *

Relation to the Primary Applicant: (if any)
Full Name:
Social Insurance #:
Drivers License #:
Date of Birth: (mm/dd/yyyy)
Current Address:
City or Town:

Province/Territory:
Postal Code:
Home Phone:
Time at Current Address:
Monthly Rent/Mortgage Cost:
Do they Own, Rent or Other?
 Own
Rent
Other
Employment:
 Current Employer:
or Self Employed
Work Phone:
Gross Monthly Income:
Position:
How long have you worked here?
Other Income Source (**):
Other Income 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.

SECTION THREE . . . . . . . . . . . . . REFERENCES

Reference #1

Name:
Relationship:
City or Town:

Province/Territory:
Home Phone:

Reference #2

Name:
Relationship:
City or Town:

Province/Territory:
Home Phone:

SECTION FOUR . . . NOTICE TO APPLICANT(S)

The information in this customer Statement-Credit Application will be submitted to Harley-Davidson® Financial Services Canada, 4150 Technology Way, Carson City Nevada, 89706, for consideration as to whether it meets the credit requirements of Harley-Davidson® Credit Corp.

Vehicle insurance covering the collateral is required for the full term of the loan, at your expense, for liability and physical damage coverage for both collision and comprehensive loss to include such perils as FIRE, THEFT and VANDALISM. Harley-Davidson® Credit Corp must be listed as a LOSS PAYEE AND ADDITIONAL INSURED. Verification will be provided by the applicant 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.
Comments:
Please Note: If you have any questions please contact Josee McMillan or Kelly Gariepy at Calgary Harley-Davidson ® 1.403.250.3141.

SECTION FIVE . . . . . . APPLICANT AUTHORIZATION

 

By checking this box:          I hereby certify:

that the information contained in this Customer Statement - Credit Application is complete and accurate to the best of my knowledge.

By checking this box:          I hereby authorize and consent:

to the collection, use and release of any credit, personal or other information about me (including credit and employment history) at any time, from, to or with any credit bureau, reporting agency, credit grantor, insurer, my employer or other person. I understand that all such information shall be collected and used by Harley-Davidson® Credit, its affiliates and service providers for assessing my creditworthiness in connection with this Application and my ongoing creditwothiness, for offering other products and services to me and for determining my eligilibility for any other products or services.

By checking this box:          I acknowledge:

that I have read the Notice to Applicant(s) section and I agree to the terms and conditions set forth in this Customer Statement - Credit Application.

To send this application by email to Calgary Harley-Davidson®/Buell®, click on the SUBMIT button. This form is encrypted with 128 bit SSL security to protect your privacy.