2017 Harley-Davidson® Ultra Limited Black Quartz First name Required Last name Required Phone Required Email Required Vehicle Required Please select Forty-Eight® Low Rider™ ST Road King™ Special Street Glide™ Special Ultra Limited Preferred date Required Preferred time Required Your enquiry Can we contact you via email? Can we contact you via phone? Can we contact you via text? ImportantI understand, and accept, that motorcycling has its dangers and involves the risk of damage to clothing and valuables. More importantly, I fully understand, and accept, that motorcycling involves the risk of injury and death. I declare that I am an experienced motorcyclist, licensed to ride motorcycles of the above capacity and that I am participating voluntarily.In case of an accident you must notify us immediately.You are responsible for all fines incurred during the period of the rental.The machine is to be ridden by you only, who warrants that he/she holds a full valid A Class Motorcycle Licence held for at least two years.The machine is to be returned in the same condition as the commencement of the test ride.Rental DeclarationI declare to Belfast Harley-Davidson that:I am over 23 and under 69 years of ageI am the person whose name, address, and eligibility details are set out above, and all such details are accurate.I have not had my driving licence revoked or had any restrictions imposed during the past 3 yearsI have no more than 9 penalty points on my driving licence during the past 3 years & have no prosecution or police enquiry pending & have no disabilities or illnesses that may affect my ability to drive that have not been notified to DVLA & have not been involved in an accident or loss in the past 3 years.I will ride with care for myself and others, including any passenger.I understand that Belfast Harley-Davidson is permitting me to carry out an unaccompanied rental of the motorcycle in reliance of the accuracy of this information and this declaration. In consideration of Belfast Harley-Davidson permitting me to carry out such a rental, I agree to indemnify and keep indemnified Belfast Harley-Davidson against all such costs, losses, claims and liabilities they may incur as a result of any inaccuracies in such information, and/or arising out of my possession or use of the machine, to the extent that such losses, etc (including, but not limited to losses etc resulting from a conversion, theft, abandonment or confiscation of the machine). I agree to pay the first £500.00 of any claim/damage as a result of my usage of the vehicle. Submit This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
