Secure Finance Application

Statement of Consent

By your signature, you certify that you have completed this application to obtain credit, and that all information provided by you for this application is true, correct and complete. You understand and agree that this application and related credit information will be forwarded to third party lenders and/or financial institutions on your behalf. You authorize Loewer Powersports to share the results of any credit report, credit investigation or employment investigation (including the information contained in this application) with third party lenders on your behalf, and any other person assisting you in obtaining an extension of credit.

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

YOUR CREDIT APPLICATION IS GOING THROUGH A SECURE WEBSITE AND YOUR IDENTITY IS SAFE

Application Date

Initial Here

Co-Applicant's Initial Here

Vehicle Information

Type

Condition

Year

Make

Model

Down Payment

Your Contact Information

Name As It Appears on Driver's License

First Name

Middle Name

Last Name

Driver's License

Mobile Phone

Residence Phone

E-mail

Social Security Number

Male / Female

Date of Birth

Marital Status

Spouse Name

Spouse Income

Physical Address Information

Physical Address

City

State

Zip

County

Mailing Address Information

Mailing Address

City

State

Zip

County

Housing Information

Do you Rent or Own your home, or other?

LandLord / Mortgage Holder

Rent / Mortgage Monthly Amount

Mortgage Balance

Time at Current Residence

Previous Residence (If less than 2 years at Current Residence...)

Address

Previous Phone #

City

State

Zip

How long at Previous Residence

Banking Information

Name Of Bank

Account Types

Employer Information

Type of Employment

Where did you retire from?

How long have you been retired?

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Other Income

Other Income Source

Other Income Frequency

Previous Employer Information (If less than 3 years at Current Employer...)

Occupation

Employer Name

Employer City

Employer State

Employer Phone

Time at Employer

Additional Comments

Please include any information that you feel may help us process your application.

Joint Applicant Contact Information

First Name

Middle Name

Last Name

Driver's License

Mobile Phone

Residence Phone

E-mail

Social Security Number

Date of Birth

Joint Physical Address Information

Physical Address

City

State

Zip

County

Joint Mailing Address Information

Mailing Address

City

State

Zip

County

Joint Applicant Housing Information

Do you Rent or Own your home, or other?

LandLord / Mortgage Holder

Rent / Mortgage Monthly Amount

Time at Current Residence

Joint Applicant Previous Residence (If less than 2 years at Current Residence...)

Address

City

State

Zip

How long at Previous Residence

Joint Applicant Banking Information

Name Of Bank

Account Types

Joint Applicant Employer Information

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Other Income

Other Income Source

Other Income Frequency

Joint Previous Employer Information (If less than 3 years at Current Employer...)

Occupation

Employer Name

Employer City

Employer State

Employer Phone

Time at Employer

Joint Applicant Additional Comments

Please include any information that you feel may help us process your application.

Sign Here

Joint Applicant Sign Here

References

Name

Phone

City

State

Relationship

Name

Phone

City

State

Relationship