Police & Escort
Request form - 2001 Model Year

Law Enforcement Agency to Complete
Purchaser: __________________________________________________________________________________
                                   (must correspond with the Sales and Warranty Registration submitted by the dealer)
Purchaser's Address: _________________________________________________________________________
City/State/Zip: ______________________________________________________________________________
Purchaser's Phone and Fax Number: _____________________________________________________________
Purchase Order #: ___________________ Lease:   $1.00   Other (please list): ____________________________

Harley-Davidson Motor Company requires a copy of either a purchase order or lease. We will accept a copy of a department's curent lease (or a copy of the lease that the dealer intends to use) along with a letter of intent from the department stating the lease request or renewal. We will require a copy of the signed lease when units are delivered. Other methods of payment will require verification (copy of check, etc.)

Signature of Authorized Purchasing Agent: ____________________________ Title/Rank: ___________________

Police Fleet motorcycles are not eligible for transfers of the manufacturer's limited warranty.

For Fleet/Escort Purchasers
Please provide a copy of the following documentation:

__ 1. Business License (mandatory)
__ 2. Corporate Articles of incorporation, or other charter documents, or provide a letter on company letterhead stating your business is a
          sole proprietorship, or general partnership.
__ 3. Verification of emergency option equipment (i.e. siren system, strobe system, etc.) or provide the VIN number of the current motorcycle
          the equipment will be transferred from.
** Order requests will be canceled if proper documentation is not received within 30 days **
Note: Order requests from legitimate law enforcement agencies take priority over all other Police Fleet order requests.
Escorts orders will not be accepted without the above documentation.

To be completed by Dealer
Date Submitted: _______________ City/State: ________________________ Dealer # _____________________

Dir. Signature: __________________________________________________ Fax #: _______________________

Color:   __ Birch White

__ Other: Please list color (s) below. Special paint requests require the completion of a special paint form - these requests
      must meet the current "Classic" paint scheme. List PPG color codes only: _____________________
FXDP
1GKV11-DOM		 Qty   FLHP1
1FHW11-DOM		 Qty   FLHTP1
1FMW11-DOM		 Qty

Police Sales Use
Rejected/Reason: ____________________________________________________________________________
2nd Follow-up: _____________ 3rd Follow-up: _____________ Approved: ___________ Rejected: ___________
Factory Order # (s): ___________________________________________________________________________
Schedule: ___________________________________________________________________________________