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Aftercare Mechanical Repair Agreement
Aftercare
Mechanical Repair Agreement
Applicant
First Name:
Middle Initial:
Last Name:
Address:
City:
State:
Zip Code:
Home Phone:
-
-
Work Phone:
-
-
Date:
/
/
Vehicle Information
Year:
Manufacturer:
Model/Engine Displacement:
Vehicle Identification Number:
Hour/Odometer Reading:
Vehicle Purchase Date(Effective Date):
/
/
Vehicle Sales Price:
Desired Coverage
Term desired:
12 month
24 month
Other Information
Is there a photograph of the bike you intend to purchase on cycletrader.com's website ?
Yes
No
What is the reference number of that Ad ?
Is the unit being sold by an individual ?
Yes
No
Is the unit being sold by a dealership ?
Yes
No
If a dealership - What is the name of the dealership? What is the phone number?
Did you test drive the bike? What problems did you notice with the bike ?
Have you purchased the bike already ?
Yes
No
If so, what date did you purchase the bike ?
Do you plan to have the bike serviced by a dealership ?
Yes
No
If so, what is the name and phone number of the dealer you plan to have service the bike ?
Do you own other power sports equipment ?
Yes
No
Are you interested in information on service contract for your other powersports products ?
Yes
No
For Internal Use Only
Motorcycle
Scooter
ATV
Snowmobile
Watercraft
Lawn & Garden
Power Equip.
New
Used
Agreement Number:
Agreement Sales Price:
Recreation Interruption Price:
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