First Name      Last Name

Address1

Address2

Address3

Country    

Telephone             Fax No

E-Mail  

Tour No    2008-01 (10/11/2008) 2008-02 (11/15/2008) 2008-03 (12/13/2008) 2009-01 (01/10/2009) 2009-02 (02/14/2009) 2009-03 (03/14/2009) 2009-07 (04/18/2009)     Motorcycle Electra Glide Road Glide Road King Heritage Softail Fat Boy Dyna Wide Glide Dyna Low Rider Sportster   

  Participants/ Accommodations 1 Bike / 1 Rider Double Occupancy $2,400.00 US 1 Bike / 1 Rider Single Occupancy $3,100.00 US 1 Bike / 2 Rider Double Occupancy $4,100.00 US 2 Bike / 2 Rider Double Occupancy $4,600.00 US

Cr Card American Express Discover Card Master Card Visa Card  Card No   Exp Date 01 02 03 04 05 06 07 08 09 10 11 12 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

I agree to a charge of $500.00US to my credit card as DEPOSIT for motorcycle guided tour. I further agree to be charged the balance of the total tour amount 45 days before the tour date unless other arrangements have been previously made.