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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*

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 +$ 100.00

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:

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Name

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