MOTORCYCLE registration form

* Required

* Rider's Name:

Age: Sex:

* Address:

* City:

* State:

* Zip Code:

* Phone Number:

Cell Phone:

* Email Address:

(1) Motorcycle

Year:

Brand of Motorcycle:

Model:

Color:

License Plate #:

(2) Motorcycle

Year:

Brand of Motorcycle:

Model:

Color:

License Plate #:

Do you pull a trailer?

Yes No

Trailer Make:

Trailer License Plate #:

Do you have a sidecar?

Yes No

Referred by:

MTS PLANS

(please check only one box)
NOTE: Motorcycles manufactured prior to 1980 are eligible for the Economy Plan only.

PREMIER PLANS - MTS pays for the first $300 of your tow from point of pickup to point of delivery. Coverage is for two motorcycles only. Each additional motorcycle is $5.00 per year extra. All motorcycles must be registered with MTS. Only 1980 and newer motorcycles are eligible for coverage.

Single Membership, 1 Year $89.95 Single Membership, 2 Years $175.00 ONE RIDER

Family Membership, 1 Year $175.00 Family Membership, 2 Years $345.00 Covers two riders in the same household

DELUXE PLANS - MTS covers the first $150.00 of the tow from point of pickup to point of delivery. Coverage is for two motorcycles only. Each additional motorcycle is $5.00 per year extra. All motorcycles must be registered with MTS. Only 1980 and newer motorcycles are eligible for coverage.

Single Membership, 1 Year $49.95 Single Membership, 2 Years $95.00 ONE RIDER

Family Membership, 1 Year $95.00 Family Membership, 2 Years $185.00 Covers two riders in the same household

Family Membership - 2nd rider for either the PREMIER or DELUXE plans
Rider's Name:
Rider's Age:	Sex:
Year of Motorcyle:	Brand of Motorcycle:
Model:	Color:
License Plate#:

COLD COUNTRY PLAN - Same as Deluxe Plan, single membership, except coverage is only available from 1 April through 30 September. Available only to residents of the following states: AK, CT, DE, IA, ID, IL, IN, MA, MD, ME, MI, MN, MT, ND, NE, NH, NJ, NY, OH,OR,PA, RI, SD, VT, WA, WI, WV, WY and Canada.

1 Year $30.00 2 Year $60.00

ECONOMY PLAN - MTS dispatches, member pays for tow.

1 Year $20.00 2 Year $40.00

EMERGENCY SERVICE PLAN - (Optional) MTS pays 100% of replacement cost, excluding labor, of tire (includes trailer/sidecar), battery, fuel pump; and throttle, brake or clutch cables, should they fail on your MTS registered motorcycle when you are at least 100 miles from your place of residence. Must be in conjunction with an MTS tow.

1 Year at an additional $75.00 per motorcycle

** To join immediately by credit card or
for more information call:
800-999-7064
319-984-6124
Fax: 319-984-6132
Monday - Friday, 9am-3pm (CST)

CREDIT CARD INFORMATION - THIS FORM IS SECURE

When did you want your membership to start?
(ATTN: There is a 3 day waiting period)

Your membership will be automatically renewed to your credit card at the end of your expiration date each year. When you receive your renewal, you will have the option to cancel your membership at that time. A cancellation fee of $10.00 will be assessed if cancelled prior to expiration date.

Name on Card:

Bill my membership to the following credit card:

Account Number: Example: 123 - 1234 - 1234 - 12345
(Please put spaces or dashes between #s)
Expiration Date: (MM/YY)

CCV: (3 digit number on back of card at the end of the signature field)

You may also print this form out, complete it and enclose your annual membership dues, either by credit card, check or money order made out to Motorcycle Towing Services.

Mail to: 105 N. State Street
P.O. Box 559
Denver, IA 50622
Or FAX to 319-984-6132

Please allow 7-10 days to receive your membership kit (Canadian payments in U.S. funds only).

MTS reserves the right to accept or deny membership.

105 N. State Street - P.O. Box 559 - Denver, IA 50622 | TOLL FREE: 800-999-7064 | PHONE: 319-984-6124 | FAX: 319-984-6132
This site created and powered by VGM Forbin. Copyright 2008 : MOTORCYCLE TOWING SERVICES, L.C. All Rights Reserved.