Quantrill Harley-Davidson Motorcycle Rentals and Tours : Reservation

TOUR RESERVATION FORM

All fields with * are required, however, the more information you provide, the less time you will spend at the counter when you come to pick up your bike.

Reservations are valid only upon Quantrill's confirmation.

Minimum down payment: $300 (non-refundable)

*	First Name:
*	Last Name:
*	Address:
*	City:
*	State/Province:
*	Zip/Postal Code:
*	Country:

*	Home Telephone:
*	Day or Cell Phone:
	Fax:
*	Email Address:

*	Drivers License Number:
*	License Expiration Date:
*	Licensed State:
*	Date of Birth:

*	Card Type (for down payment)
*	Credit Card Number:
*	Expiration Date:
*	3 or 4 Digit Card Verify (located on the back of card)	CVV2 #

	All reservations will be confirmed by eMail

*	Requested Model 1st Choice:
	Requested Model 2nd Choice:

*	Select Tour

*	Insurance	VIP S18.00/day	EVIP $24.00/day
	Additional Insurance	PAI $7.95/day	SLI $12.95/day

*	How did you find us:
	Special notes on your reservation: