Secure Finance Application

Statement of Consent

I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience.

Please initial below to indicate that you have received a copy of our Privacy Notice and agree to all of the above.


(Initial here)
Is this a co-application?
Yes                 No
Co-Signer's Signature
Vehicle Information
$Down Payment
Your Contact Information

Name As It Appears on Drivers License

First Name
Middle Name
Last Name
Driver's License
License Class
Driver's License State
Driver's License PIC
Driver's License Date of Issue
Driver's License Expiration Date
Second ID Number
Second ID Type
Second ID Expiration Date
Work Phone
Residence Phone
Mobile Phone
Preferred Point of Contact
Phone     E-mail
Social Security Number
Marital Status
Date of Birth
US Citizen?
Yes     No
Physical Address Information
Physical Address
Mailing Address Information
Mailing Address
Housing Information
Do you Rent or Own your home, or other?
LandLord / Mortgage Holder
Rent / Mortgage Monthly Amount
Mortgage Balance
Time at Current Residence
Years Months
Market Value
Banking Information
Name Of Bank
Account Types
Name Of Bank
Account Types
Debit Card
Expiration Date
Previous Residence (If less than 5 years at Current Residence...)
State, Zip
How long at Previous Residence
 years   months 
Employer Information
Employer Name
Employer Address
Employer City
Employer State
Employer Zip
Employer Phone
Salary (Annually Gross)$
Time at Employer
 years   months 
Type of Employment
 Full   Part-Time 
Job Title
Other Income $
Other Income Source
Other Income Frequency
Previous Employer Information
Employer Name
Employer Address
Employer City
Employer State
Employer Zip
Employer Phone
Salary (Annually Gross)$
Time at Employer
 years   months
Job Title
Additional Comments
Please include any information that you feel may help us process your application.
Name:  Phone:  Relation:  Address:  City:  State:   
Name:  Phone:  Relation:  Address:  City:  State:   
Name:  Phone:  Relation:  Address:  City:  State:   
Name:  Phone:  Relation:  Address:  City:  State:   
Notice To Applicant(s)

This Credit Application - Customer Statement will be submitted to Eaglemark Savings Bank, and its successors and assigns, at P.O. Box 22048, Carson City, Nevada 89721, 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 accepdiv 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.

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 that 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 VERMONT RESIDENTS: The creditor may obtain credit reports about you 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.

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.

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.

Facts - What does Harley-Davidson financial services, inc. do with your personal information?
Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.
The types of personal information we collect and share depend on the product or service you have with us. This information can include:
  • Social Security number and income
  • Account balances and payment history
  • Credit history and credit scores
All financial companies need to share customers' personal information to run their everyday business. In the section below, we list the reason financial companies can share their customers' personal information; the reasons Harley-Davidson Financial Services, Inc. ("HDFS") chooses to share; and whether you can limit this sharing.
Reasons we can share your personal information
Does HDFS share?
Can you limit this sharing?
For our everyday business purposes - Such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus
For our marketing purposes - To offer our products and services to you
For joint marketing with other financial companies
For our affiliates' everyday business purposes - Information about your transactions and experiences
For our affiliates' everyday business purposes - Information about your creditworthiness
For our affiliates to market to you
For nonaffiliates to market to you
We don't share
To limit our sharing
  • Call HDFS Customer Service at (888) 691- 4337
  • If you have a Customer Self-Serve account for your loan, visit us online at
  • Mail the Opt-Out Form to: Harley-Davidson Financial Services (Opt-Out), Attn: Privacy Officer, P.O. Box 21489, Carson City, NV 89721-1489
Please note:

If you are a new customer, we can begin sharing your information 45 days from the date we provide this notice. When you are no longer our customer, we continue to share your information as described in this notice. However, you can contact us at any time to limit our sharing.

Call HDFS Customer Service at (888) 691- 4337
Who we are
Who is providing this Notice?
Harley-Davidson Financial Services, Inc. includes:
  • Eaglemark Savings Bank
  • Harley-Davidson Credit Corp.
  • Harley-Davidson Insurance Services
What we do
How does Harley-Davidson Financial Services, Inc. protect my personal information?
To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings.
How does Harley-Davidson Financial Services, Inc. collect my personal information?
We collect your personal information, for example, when you
  • Apply for a loan or give us your income information
  • Apply for insurance or provide employment information
  • Show your government-issued ID or pay your bills
We also collect your personal information from others, such as credit bureaus, affiliates, or other companies.
Why can't I limit all sharing?
Federal law gives you the right to limit only
  • sharing for affiliates' everyday business purposes - information about your creditworthiness
  • affiliates from using your information to market to you
  • sharing for nonaffiliates to market to you
State laws and individual companies may give you additional rights to limit sharing. See below for more on your rights under state laws.
What happens when I limit sharing for an account I hold jointly with someone else?
Your choices will apply to everyone on your account and / or policy.
Companies related by common ownership or control. They can be financial and nonfinancial companies. Our affiliates include companies such as:
  • Harley-Davidson Motor Company
  • Harley-Davidson Inc.
Companies not related by common ownership or control. They can be financial and nonfinancial companies.
  • Harley-Davidson Financial Services, Inc. does not share with nonaffiliates so they can market to you, except as permitted by law.
Joint marketing
A formal agreement between nonaffiliated financial companies that together market financial products or services to you. Our joint marketing partners include, but are not limited to:
  • Credit card companies
  • Insurance companies
Other important information

For Vermont Residents: Your state laws require financial institutions to obtain your consent prior to sharing information about you with others. You are automatically opted out of information sharing as if you had checked both boxes on the Mail-In Opt- Out Form. If you want to opt in, please send a written request to the HDFS Privacy Officer at the address noted on the Mail-In Opt-Out Form.

For California Residents: In accordance with California law, we will not share information we collect about you with companies outside of our corporate family, except as permitted by law, including, for example, with your consent or to service your account. We will limit sharing among our companies to the extent required by California law.

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