Harley Hull Lending Services L.L.C.

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Applicant

Borrower Information

First Name*

MiddleName

Last Name*

Suffix

Phone Number*

Email*

Preferred Contact Method*

Social Security No. **

Date of Birth*

**Upon acceptance, additional information, including your Social Security number, will be required to complete your loan application. Please note that HHLS will not conduct a credit check until we proceed with finalizing your loan. Furthermore, providing your Social Security number enables HHLS to accurately monitor your bankruptcy case until its resolution.

Address Information

Current Home Address*

Apt/Suite Number (if applicable)

City*

State*

Zipcode*

Vehicle Information

Vin*

Decode VIN

Year*

Make*

Model*

Trim

Mileage*

Color*

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Vehicle Condition*

Current Lender Name*

Approx. Balance of Current Loan*

Current Monthly Payment*

Current Interest Rate*

Do you have a bankruptcy attorney?*

Attorney Name

Attorney Phone Number

Attorney Email

Is bankruptcy a joint filing with spouse or partner?*

Joint Filer First Name

Joint Filer Last Name

Joint Filer Phone Number

Joint Filer Email

Terms & Conditions

By completing this application, you authorize Harley Hull Lending & Services, LLC (HHLS) to release any of your information for the following purposes:

Conducting a background search on your credit and full legal/criminal records.
Engaging in business with any legal agency as required to maintain the integrity of your outstanding consumer loan.

You agree that you may request, or ask another legal agency to contact HHLS for information concerning your consumer loan, and authorize HHLS to release such information.

You release HHLS from any and all liability resulting from investigations concerning your consumer loan(s). You certify that all information you disclose, in writing or verbally, is true and accurate. These investigations and inquiries fully comply with the Privacy Act of 1974 and other laws protecting your rights.

You also consent to receive communications from Harley Hull Lending & Services, LLC (HHLS), its agents, employees, and legal counsel via text messaging (SMS) and email. You confirm that the cellular number provided on this application form is your private phone number capable of receiving text messages, including confidential information. You must notify HHLS of any changes to your phone number or email address immediately. You will bear any charges related to the receipt of text messages.

You authorize the use of the provided email address and cellular number for all communications, including private or confidential information, by HHLS, its agents, employees, and legal counsel. This authorization must remain in effect throughout the loan duration and can only be revoked in writing.

You give express consent to HHLS, its agents, employees, and legal counsel to conduct business electronically, including but not limited to repossession and/or collection activities, using the provided email address(es) or any new email address(es) given verbally or in writing. HHLS may also attempt to contact you via Facebook or other social media services.

You understand that HHLS, its agents, employees, and legal counsel cannot guarantee the privacy or security of information communicated via email. You waive any claims against HHLS, its agents, employees, and legal counsel related to electronic communication, including but not limited to claims of privacy or security breaches, unauthorized access, or disclosure.

By completing this application, you acknowledge and agree to the above terms.*

If your application is accepted and HHLS decides to proceed with your loan, the final documents will be signed electronically unless you request an in-person signing. Additionally, as a condition for completing your loan with HHLS, a GPS tracking device must be installed in the vehicle.*

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