Name:

Address:

City:                                                            State:                         ZIP:

Country:

Preferred Phone #:                                                                            r Cell r Home  r Work

Alternate Phone #:                                                                            r Cell r Home  r Work

Email:

Age - 25 years or older:  r YES  r NO         Birth Date:   ______ /______ /______

Years of Motorcycle Operation:                 Total Miles of Motorcycling:

Current Motorcycle(s) owned:

Motorcycle Endorsed License:  r YES      r NO    License Number:

Your Height:                          Passenger Name:

Motorcycle Choice:  #1                                               Choice #2

Rental Dates: Start Date: ______ /______ /______  End Date: ______ /______ /______

            Rental Days:   ___________           (include first and last day of rental)

Deposit Paid By:     r Credit Card      r Check        r Money Order

Credit Card Type:  r  VISA          r MasterCard         r Discover       

Card Number: ______________   ______________ ______________  ______________

Credit Card Billing Address: ______________________________ Billing Zip Code: _______

Expires:  ____ / _____ Signature:  ______________________________________________

Send application and $250.00(US) reservation deposit to secure requested dates. 

Confirmation of dates and additional information will be emailed/mailed to you upon receipt of completed application.

Total rental amount (less deposit) due 45 days before motorcycle pickup.

Cancellation Policy - cancellations must be received in writing and are refunded on a prorated basis as follows: 

• 60+ Days Prior to arrival a  $100.00 Cancellation Fee is charged.
• 30 days prior 75% of the rental fee is refunded.
• 14 days prior 50% of the rental fee is refunded.
• 7 days prior 25% of the rental fee is refunded.
• Less than 7 days notice and no refund is given. 

Your contact initiated from:             r Internet Search   r Motorcycle Touring Company   r FaceBook    r Previous Contact   

                                                               r BMWMOA Website   r Magazine Ad    r The Motorcycle Shop   r Other _____________