Financing Form

The form is submitted using an HTTPS form action. All sensitive data is encrypted before transmission and is never sent as clear-text.

* Required Information

Contact Information

First Name*

Last Name*

Middle Name

Date of Birth*

Email*

Phone Number* (###-###-####)

SSN* (###-##-####)

Address information

Street*

City*

State*

Zip Code*

Years at Address*

Months at Address*

Do you Own/Rent/Mortgage?

Monthly Mortgage or Rent (e.g. $700)*

Previous State*

Vehicle Information

Condition

Make*

Model*

Year*

Delivery Date*

Delivery Time*

Purchase or Lease*

Down Payment

Employment Information

Monthly Gross Income*

Occupation*

Employer*

Employer Phone Number (###-###-####)*

Employer Address*

City*

State*

Zip Code*

Years Worked*

Months Worked*

Work Phone* (###-###-####)

Previous State*

Co-Signer Information

Co-signer information is optional.

First Name

Last Name

Middle Name

Address

City

State

Zip Code

Day Phone (###-###-####)

Years at Address

Months at Address

SSN (###-##-####)

Date of Birth

Monthly Gross Income

Monthly Mortgage or Rent (e.g. $700)

Current Employer

Years Worked

Occupation

TCPA and CCPA Consent

Method of Contact*

Site Token

Form Title

Form Description

Provider Id

Form Version

Source Url

Source Host

Source Path

Source Query

Clicked At Field

User Agent

sbjs Current

sbjs Promo

Form Type Field

Display Type Field

Production

Referer URL

Please complete all required fields

Disclosure

This Customer Credit Application is an application for credit from the lender. The words “You”, “Your” or “Applicant” mean each individual applicant (and all applicants collectively) identified on the first page of this Application and signing this Application. The words “We”, “Us” or “the lender” mean the lenders Financial Department, its designated service providers, agents, successors and assigns.

By signing below, You acknowledge that You have received the Privacy Notice of the lender, and that You have read the Notice and Acknowledgments below and agree to the terms and conditions set forth in this Application.

NOTICE TO APPLICANT(S)

This Customer Credit Application will be submitted to the lender, for consideration of whether it meets the credit requirements of Motorcycles of Dulles’ Financial Department.

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 it.

Notice to Massachusetts residents: Massachusetts law prohibits discrimination on the basis of sex, marital status, age, or sexual orientation.

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 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. If You are married, Your signature confirms that any obligation under this account will be incurred in the interest of Your marriage or family.

ACKNOWLEDGMENTS:

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 the lender.

You certify that You are at least 18 years of age. You authorize Us to verify and obtain Your credit and employment history or other information about You in this Application. You authorize Us to obtain credit reports or similar consumer reports about You in the future from uedit reporting agencies in connection with the review, updates, extensions, renewals, modifications, servicing and collection of Your account with Us, and other legitimate purposes allowed by law. If You ,equest, We will inform You if we obtain a consumer report about You and, if so, provide the name and address of the consumer reporting agency that furnished such report. You understand and agree that We may provide Information about Your transaction with Us to third-parties (including consumer reporting agencies) for lawful purposes.

WE MAY REPORT INFORMATION ABOUT YOUR ACCOUNT TO CREDIT BUREAUS, LATE PAYMENTS, MISSED PAYMENTS, OR OTHER DEFAULTS ON YOUR ACCOUNT MAY BE REFLECTED ON YOUR CREDIT REPORT.

You authorize Us to contact any references that you provide during the credit approval process or at any time that you have a loan outstanding with Us for any purpose permitted by applicable law, and expressly authorize Us to disclose to such references that you have an account with Us. You agree that We may call You, leave You a voice, prerecorded, or artificial voice message, or send You a text, e-mail, or other electronic message for any purpose related to your accounts, products and services, or otherwise as permitted by applicable law, and that We may call or text You at any telephone number associated with Your accounts, including cellular telephone numbers, and may send an e-mail to any email address associated with Your accounts. You also agree that We may include Your personal information in any communication and may communicate with You using an automatic telephone dialing system. You understand that your service provider may charge you for communications received from Us.

You certify that: (i) the property purchased pursuant to this Application is for Your personal use; (ii) such property will be in Your possession, or under Your control, until the amount financed and all interest charges have been paid in full; and (iii) You are not purchasing any property financed through Us for the benefit or use of a person or entity other than You.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT:

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 apply for credit, we will ask you 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. Failure to provide the required information may result in denial of your request to open an account.