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BANGOR HOG
CHAPTER Mileage Awards Program – Entry Form
MEMBER INFORMATION: (To be completed by Member) Member Name: __________________________ Bangor HOG#: _________________ Phone No.: _____________ Address:________________________________________________________________ ________________________________________________________________ ________________________________________________________________
ENROLLMENT INFORMATION:
(To be completed by a Bangor HOG Chapter Officer , Road Captain or the Dealer)
Date:__________ Model:______________ VIN/Serial#:_____________________________________
Starting Mileage:______________ Authorized Signature:_________________________ Ending Mileage:_______________ Print: ____________________________
Motorcycle Odometer Replacement or Change of Motorcycle Information
TO BE COMPLETED BY DEALER ONLY Date:_________ New Model:_________________________ VIN/Serial#:_______________________
Starting Mileage:______________ Dealer Signature:__________________________ Print: ________________________________
Ending Mileage:_______________ Dealers Signature:_________________________ Print: ________________________________
RETURN COMPLETED FOR TO: Chapter Officer or Frank Blake ©2008 Central Maine Harley-Davidson/Buell. All rights reserved. |
