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 _____________