Credit Application

You can use this handy form whether you wish to send us an on-line application or create a printable application which you can then mail, fax or bring to us in person. Simply fill out the form, then choose whether you want to send the application or print it. All applications are held strictly confidential. Please be sure to include a valid e-mail address, so we may contact you quickly if we have any questions about your application.

VEHICLE DESIRED
First, tell us a little about the bike in which you're interested.
Year	Make	Model
Any additional information:

TYPE OF APPLICATION
I am applying for (please check the appropriate box):
Individual	Individual w/ one or more co-applicant
Joint applicant & spouse)	Joint Applicants w/ an individual and one or more co-applicant

PRIMARY APPLICANT'S PERSONAL INFORMATION
Name First	Middle	Last
Social Security Number	Drivers License Number	Date of Birth

married

unmarried

separated

number of dependents:

Has applicant or spouse ever obtained credit under a different name? yes    no If yes, show name(s) here:

Will applicant be the principal driver or operator? yes    no If no, list name(s) of other parties: age(s) & relationship to applicant:

E-Mail Address:
Home Phone Number:
Current Address
Street Address:
City / State / Zip:
How long have you been living at this address?
rent     own     mobile home     living with parents
Amount of monthly rent or mortgage payment:
Landlord or mortgage holder's name:
Former Address
Street Address:
City / State / Zip:
How long did you live at this address?

PRIMARY APPLICANT'S EMPLOYMENT
Current Employer (or self-employed):
Job Description (or military rank):
How long have you held this job?
Work Phone Number:
Street Address:
City / State / Zip:

Gross Monthly Salary:
Other Income:

Source of other income:
NOTE: alimony, child support, separate maintenance income need not be revealed, unless you want it considered in granting credit.

Former Employer:
How long did you hold this job?
Street Address:
City / State / Zip:

SPOUSE'S PERSONAL INFORMATION
Name First	Middle	Last
Social Security Number	Drivers License Number	Date of Birth

SPOUSE'S EMPLOYMENT
Current Employer (or self-employed):
Job Description (or military rank):
How long have you held this job?
Work Phone Number:
Street Address:
City / State / Zip:

Gross Monthly Salary:
Other Income:

Source of other income:
NOTE: alimony, child support, separate maintenance income need not be revealed, unless you want it considered in granting credit.

Former Employer:
How long did you hold this job?
Street Address:
City / State / Zip:

PERSONAL REFERENCES
Nearest relative (not living with you)	Relationship to you
Full address of relative:
Relative's Phone Number:
Name of a close friend:
Friend's phone number:
Friend's full address:

FINANCIAL INFORMATION include joint applicant's information
TYPE OF ACCOUNT	INSTITUTION NAME
Savings/Money Market:
Checking Account(s):

DEPARTMENT STORE CREDIT CARDS

STORE NAME

MAJOR CREDIT CARDS
TYPE OF ACCOUNT	INSTITUTION/BANK NAME
Master Card:
Visa:
American Express:
Other Cards:

OTHER TYPES OF CREDIT
TYPE	INSTITUTION NAME	MONTHLY PAYMENT
Auto:
Bank:
Credit Union:

I certify that the statements above are true and complete. I understand that the AHFC will be asked to buy the contract involved in this sales transaction. I authorize Blue Ridge Powersports and the AHFC to check the information on this application, check my credit references with credit bureaus and others, verify my employment and request additional information from them, including a credit report. AHFC may give information about how I have handled this account to credit bureaus or others who may lawfully receive such information. I authorize the AHFC to give a copy of this application to anyone who has agreed to pay debts incurred on the basis of this application. I authorize AHFC to communicate the reason(s) for action taken on this application to Blue Ridge Powersports.

Has applicant or spouse voluntarily surrendered or had any items repossessed? yes    no

Has applicant or spouse ever been the subject of bankruptcy proceedings? yes    no

Can the credit references/history of applicant or spouse be verified in any other name? yes    no If yes, what name(s):

By placing my initials and date in the spaces below and submitting this form, I am authorizing Blue Ridge Powersports and AHFC to check my credit, as outlined in the stipulations above. initials:    today's date:

Send Application On-Line     Create Printable Application