EmailMe Form - Credit Application

Name *
First MI Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Monthly Housing Payment *
$ Dollars . Cents
Length of Time at Residence *
Phone *
### - ### - ####
Date of Birth *
MM / DD / YYYY
Social Security Number *
no spaces
Drivers License Number *
Please include issuing State & Exp. Date
Employment Name & Address *
Please include Phone Number
How Long Worked There? *
Gross Monthly Income *
$ Dollars . Cents
Applicant Reference #1 *
Name & Phone Number
Applicant Reference #2 *
Name & Phone Number
Desired Length of Loan
Desired Down Payment *
$ Dollars . Cents
Most lenders will require a minimum 10% down payment, however, depending on credit worthiness, you may be entitled to no or low down payment offers.
Bike To Be Financed *
2015 Ural Gear Up Asphalt
2015 Ural Patrol Metallic Burgundy
2015 Ural Patrol Metallic Green
2015 Ural Gear Up Urban Camo
2007 Ultra
2007 Boss Hoss 502
2007 BDM Mastiff Green
2008 BDM Mastiff tribal
2009 BDM Coyote
2006 BH 57 Chevy Trike
2006 BH 32 Coupe
2006 BH Willys Trike
2007 BDM Bulldog
2009 BDM Wolf
1996 BH Clutch Bike
2006 BH Willys Blk/Red Trike
2003 BH Bike
2014 Cushman II Highlander 9hp
2015 Cushman II 14hp Yellow Step Thru
2014 Cushman II 14hp Highlander
2015 Cushman II 9hp Light Blue
2015 Cushman II 9hp Black
2015 Cushman II 9hp Dark Blue
2015 Cushman II 9hp Red
2015 Cushman II 9hp White
2015 Cushman II 14hp Light Blue Step Thru
Other ( Use if bike is not listed)
If the bike is not listed or you have been quoted a special purchase price, list that here.
Add Shipping Costs to Finance Amount?
Yes
No
Undecided
If you are purchasing from out of state and would like to arrange shipping costs to be included into your loan, please select yes. Local residents select NO.
Email *
Please include a valid email address. All loan approvals and/or documents will be sent to this address.

Confirm
File Upload

Add File

Use this file upload to upload any useful documents in helping us determine eligibility, or to submit copy of drivers license, W2's, Paycheck Stubs or letter of recommendations and statement of facts.
Joint Applicant Info
If you are applying for a joint applicant loan, please have your co-signer or joint applicant fill out below section.
Name
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone
### - ### - ####
Date of Birth
MM / DD / YYYY
Employemnt Name, Address & Phone
Signature *
Clear
Please Sign Application with Mouse. Click and hold mouse while signing.

Joint Applicant Info