Robinson Motorcycle • since 1958 •

Canada's Largest Selection of Pre-owned HARLEY-DAVIDSON® Motorcycles!

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About You

Full Name
Birthdate
Marital Status
Social Insurance Num
Drivers Licence
Cell phone
Email Address

Where you live:

Address1
Address2
City
Province
Postal Code
How long?
Home Phone
Rent or Own Home?	Own Rent

If you rent:

Rent (per month)

If you own:

Home Value
Mortgage owing
Payment (per month)
Who is it held by

Previous address if less than 2 years at present address

Address1
Address2
City
Province
Postal Code

Employment Info:

Present Employer
City
Phone Number
How long worked there?
Contact person (to verify emp)
Occupation
Gross Monthly Income

Previous employer if less than 2 years

Previous Employer
City
Phone Number
How long worked there?
Contact person (to verify emp)
Occupation
Other Income (monthly)

Your Bike Plans:

Bike year and model
Bike Stock #
Down Payment
Desired Monthly Payment

519-825-4222 · info@RobinsonMotorcycle.com · 2469 Talbot Trail E, Wheatley, ON N0P 2P0
hours: Mon-Fri 9:00-5:30, Wed night until 8:00, Sat 9:00-2:00, Closed Sun