Dealer Order Form Place your orders online. If you have any questions, give the corporate office a call at (815) 434-7900. Dealer InfoDealership Name*Name*Of the person filling out this form. First Last Email*Best email at which to reach you. Customer InfoName* First Last Company Name(If applicable.)Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email Motorcycle InfoMotorcycle*(Please be specific) Year Make Model CC Does the motorcycle have bags?*No bags.Yes, stock hard bags.Yes, stock soft bags.Yes, after market bags.Bag Info Brand Total Width (Outside Left to Outside Right) Voyager InfoKit Style*(Select Kit Style)StandardCustomClassicDetailed Document to Help Determine Voyager Identification Information Please reference the Rear Assembly Trimming document to find out whether the rear assembly for the motorcycle listed on the order will be trimmed at MTC before it is shipped or if it will require trimming by the dealer, customer, or a local body shop.Lights & WiringNo lights & wiring.Tombstone lights & wiring.Beehive lights & wiring.Wiring harness only.Lights & WiringNo lights & wiring.H-D Style lights & wiring.Tombstone lights & wiring.Beehive lights & wiring.Wiring harness only.Fender Lights(The rear assembly has H-D Style on it. We recommend matching the fender lights, but ultimately, it's up to the customer.)H-D Style lights & wiring.Tombstone lights & wiring.Beehive lights & wiring.Rims & Tires13" Chrome Rim & Black Wall Tire (Standard)15" XCite Phantom Chrome Rim & Black Wall Tire15" XCite Gunmetal Machine Face Rim & Black Wall Tire13" Chrome Rim & Wide White Wall TireFender Shields Add Fender Shields Reverse by VoyagerThe reserve option requires a wheel upgrade to one of the 15" options for the gear drum to fit. Add Reverse by Voyager DO NOT PROCEED You must upgrade to one of the 15" wheel options for the Reverse gear drum to fit within the Voyager rim!DO NOT PROCEED You must upgrade to one of the 15" wheel options for the Reverse gear drum to fit within the Voyager rim!PaintFinished Glossy BlackPrimer GrayPainted to Match | One-TonePainted to Match | Two-TonePaint Info Vehicle Identification Number (VIN) Color Name(s) and/or Code(s) Pin Striping Add Pin Striping We use 3M stick-on pin striping. We are rarely able to get the exact pin stripe color and size, but we will try to match it as closely as possible.Pin Striping(Please provide us with the color(s) and width(s) of the pin striping desired. It is difficult for us to replicated the pin striping exactly, but we will get as close as our color options allow.)Shipping InfoShipping Method*[Please Select Shipping Method]Ship to Dealer LocationDrop Ship to Customer at 'Customer Info' AddressDrop Ship to New AddressSending TruckPick UpNew Shipping Address Company / Customer Name Attention Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Shipping Options Lift Gate Delivery Call Before Delivery Order Confirmation & PaymentI have confirmed that all of the information in this order is accurate and understand that I, the dealership or distributorship, is responsible for any mistakes or problems caused by incorrect, or lack of, information.* Check here if the above statement is true. Payment Method*[Preferred Method of Payment]Credit Card on FileWill Call with Credit CardBank (Wire) TransferNet 30 (if eligible)Other... (Define below in notes).(Do not share your credit card information through this form. It is not secure and your information could be stolen if you do so.)Notes(If you have any specific requests for the order or shipping, include them here.) ORDER FORM REFERENCES Retail Prices Bikes We Can Fit Rear Assembly Trimming Freight Charges If you have any questions about the order form or any prices, please reference the above "Retail Prices" document or call the corporate office at (815) 434-7900.
