TEST_ LEADER BOARD

USED - 3 Year A.P.E Warranty

"*" indicates required fields

BIKE DETAILS

Manufacture Date

MM/YYYY

Registration #*

ABC123

Model*

Odometer*

Vin/Frame#*

Engine#

Motorcycle Purchase Date*

A.P.E Performance Package*

Cost of Modifications*

Date of Modifications*

Authorized A.P.E Agent (Who performed the modifications)

Select State*

Message

QLD

NSW

VIC

ACT

TAS

How much is your Harley-Davidson insured for?*

Would you like to add Roadside Assistance to your A.P.E warranty for $300?

Road Side Assistance*

Yes

GENERAL COVER

Flat Battery - Jump start Motorbike.
Flat Tyre - Transport Motorbike.
Out of Fuel - Supply minimum of 5 litres of fuel.
Free Towing (Breakdown) - Towing up to 20km free service radius.
General Assistance - We can relay urgent messages and arrange for alternative transport.

Customer Details

Name*

First Last

Date of Birth*

Gender*

Male

Female

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Phone*

USED - 3 Year A.P.E Warranty*

Price:

Company

This field is for validation purposes and should be left unchanged.

USED - 1 Year A.P.E Warranty

"*" indicates required fields

BIKE DETAILS

Manufacture Date*

MM/YYYY

Registration #*

ABC123

Model*

Odometer*

Vin/Frame#*

Engine#

Motorcycle Purchase Date*

A.P.E Performance Package*

Cost of Modifications*

Date of Modifications*

Authorized A.P.E Agent (Who performed the modifications)

Select State*

Message

Select Dealer

How much is your Harley-Davidson insured for?*

Would you like to add Roadside Assistance to your A.P.E warranty for $100?

Road Side Assistance*

Yes

GENERAL COVER

Flat Battery - Jump start Motorbike.
Flat Tyre - Transport Motorbike.
Out of Fuel - Supply minimum of 5 litres of fuel.
Free Towing (Breakdown) - Towing up to 20km free service radius.
General Assistance - We can relay urgent messages and arrange for alternative transport.

Customer Details

Name*

First Last

Date of Birth*

Gender*

Male

Female

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Phone*

USED - 1 Year A.P.E Warranty*

Price:

Untitled

This field is for validation purposes and should be left unchanged.

NEW - 2 Year A.P.E Warranty

"*" indicates required fields

BIKE DETAILS

Manufacture Date

MM/YYYY

Registration #*

ABC123

Model*

Odometer*

Vin/Frame#*

Engine#

Motorcycle Purchase Date*

A.P.E Performance Package*

Cost of Modifications*

Date of Modifications*

Authorized A.P.E Agent (Who performed the modifications)

Select State*

Message

Select Dealer

How much is your Harley-Davidson insured for?*

Would you like to add Roadside Assistance to your A.P.E warranty for $200?

Road Side Assistance*

Yes

GENERAL COVER

Flat Battery - Jump start Motorbike.
Flat Tyre - Transport Motorbike.
Out of Fuel - Supply minimum of 5 litres of fuel.
Free Towing (Breakdown) - Towing up to 20km free service radius.
General Assistance - We can relay urgent messages and arrange for alternative transport.

Customer Details

Name*

First Last

Date of Birth*

Gender*

Male

Female

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Phone*

NEW - 2 Year A.P.E Warranty*

Price:

Comments

This field is for validation purposes and should be left unchanged.

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