Dealer application form

Thank you for your interest in becoming a dealer of Europe's leading distributor of parts & accessories for Harley-Davidson and Custom motorcycles. Please fill out the complete form. All fields with a * are mandatory.

		Basic information
	Company name		*
	Address		*
	Zip / Postal code		*
	City		*
	Country	Select... Austria Belgium Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Japan Latvia Lithuania Luxembourg Malta Norway Poland Portugal Slovakia Slovenia Spain Sweden Switzerland The Netherlands United Kingdom	*
	Phone		*
	Fax		*
	Email		*
	Website
	VAT no.		*
	Chamber of Commerce		*

Copy of Chamber of Commerce registration

* (PDF/JPG format; Max. size 2 MB)

Business hours

		Monday
		Tuesday
		Wednesday
		Thursday
		Friday
		Saturday
		Sunday

		Contact information - Owner
	Name(s)		*
	Email
	Phone
	Mobile

		Contact information - Sales
	Name
	Email
	Phone
	Mobile

		Contact information - Purchasing
	Name
	Email
	Phone
	Mobile

		Shipping address
		Same as business address

	Name
	Address
	Zip / Postal code
	City
	Country	Select... Austria Belgium Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Japan Latvia Lithuania Luxembourg Malta Norway Poland Portugal Slovakia Slovenia Spain Sweden Switzerland The Netherlands United Kingdom

		Invoice address
		Same as shipping address

	Name
	Address
	Zip / Postal code
	City
	Country	Select... Austria Belgium Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Japan Latvia Lithuania Luxembourg Malta Norway Poland Portugal Slovakia Slovenia Spain Sweden Switzerland The Netherlands United Kingdom

Show this address on the website

Address (Basic information) Shipping address Billing address

		Preferred payment method	*
		Cash on delivery (COD)
		Pre-payment by wire transfer
		VISA-card
		Master card

		Business type
		Authorized Harley-Davidson dealer
		Official Harley-Davidson service center
		Un-authorized Harley-Davidson dealer
		Importer / Distributor
		Manufacturer
		Franchise-partner of:
	Percentage Harley-Davidson	%

		Specialized in
		Retail sales
		Mail order
		Wholesale
		Repairs / Maintenance
		Bike building
		Performance modifications
		Parts development
		Clothing

		Pictures
	Shop front incl. sign		* (JPG format; Max. size 2 MB)
	Shop inside		* (JPG format; Max. size 2 MB)
	Workshop		* (JPG format; Max. size 2 MB)
	Other		(JPG format; Max. size 2 MB)

Sending the form can take a while because of the attachments.