Important:
Notice to Applicant(s) – Provide all information requested. Failure to provide legible and complete information as requested in this credit application may delay review of your credit application.
I intend to finance the purchase of the following bike:
Initials:
Initials:
Downpayment Amount:
Applicant Information:
Applicant Name
Date of Birth
Social Security Number
Email
Mobile Phone
Home Phone
Current Address
Own
Rent
Live with Parents
Other
Address
City
State
Zip Code
How long have you lived here?
Monthly Housing Payment
Joint Applicant Information:
Joint Applicant Name
Date of Birth
Social Security Number
Email
Mobile Phone
Home Phone
Current Address
Same as Applicant
Own
Rent
Live with Parents
Other
Address
City
State
Zip Code
How long have you lived here?
Monthly Housing Payment
Applicant Employment Information:
Current Employer
Work Phone
Gross Income per month:
How long have you worked here?
Other Income Amount
Other Income Source
Spousal Income (if not joint applicant)
*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.
Joint Applicant Employment Information:
Current Employer
Work Phone
Gross Income per month:
How long have you worked here?
Other Income Amount
Other Income Source
Spousal Income (if not applicant)
*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.
References:
Reference 1
Phone
City
State
Reference 2
Phone
City
State
Reference 3
Phone
City
State
Reference 4
Phone
City
State
By signing below, I acknowledge that I have received the Privacy Notice of FreedomRoad Financial, a loan production office of Evergreen Bank Group, an Illinois chartered banking institution, and that I have read the notice below and I agree to the terms and conditions set forth in this Customer Credit Application.
I hereby certify that the information contained in this Customer Credit Application is com- plete and accurate to the best of my knowledge.
Notice to Applicant(s) and Authorization by Applicant(s)
This Customer Credit Application will be submitted to FreedomRoad Financial, a division of Evergreen Bank Group, at 10605 Double R Blvd., Suite 100, Reno, NV 89521 for consideration of whether it meets the credit requirements of FreedomRoad Financial.
Applicant(s) hereby authorize(s) an investigation of his/her/their credit and employment history. Applicant(s) understand(s) that his/her/their credit and employment history will be used, along with this Customer Credit Application, in determining his/her/their eligibility for credit approval by FreedomRoad Financial.
Notice to California residents: Regardless of your marital status, you may apply for credit in your name alone.
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 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 it.
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 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.
Signatures
Applicant signature
Joint Applicant signature
The parties agree that this application may be executed and delivered by electronic signatures and that the signatures appearing on this application are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.
Submit Application
