MOTORCYCLE TIRE AND WHEEL PROTECTION WITH ROADSIDE ASSISTANCETire and Wheel Agreement • July 29th, 2019
Customer Name Effective Date Primary Residence Address City State ZIP Phone Email Dealer Name Phone Dealer # Address City State ZIP Tire Description, Size & Make Vehicle Year Make Model Vehicle Identification Number Vehicle Purchase Price $ Vehicle ConditionNew Used Type of Motorcycle (sport bike, touring bike, etc) Odometer Reading Agreement Purchase Price $ Agreement Term3 Year 5 Year Lienholder Name Street Address City State ZIP By my signature, I agree to the provisions of this Aftercare Tire and Wheel Agreement. I acknowledge that I have CUSTOMER SIGNATURE DATE read it and understand its provisions. This Agreement is not a warranty or insurance policy. Our entire Agreementis incorporated in this Agreement. No verbal representations have been made to me which differ from itsprovisions. I have reviewed the completed Declarations of the Agreement and attest that they are correct. Roadside Assistance is provided by AutoKnight (877) 624-1284.DEALER SIGNATURE DATE FOR OFFICE USE ONLY P
