Mileage Registration

CONSUMER INFORMATION

* Required Field:

Consumer Full Name*:


Consumer Street Address*:


Consumer City*:


Consumer State / Province*:


Consumer Zip / Postal Code*:


Consumer Phone Number*:


Consumer Email Address*:


INSTALLING DEALER INFO

* Required Field:

Dealer Name*:


Dealer Street Address*:


Dealer City*:


Dealer State / Province*:


Dealer Zip / Postal Code*:


Dealer Phone Number*:


Dealer Email Address (if available - optional):


MOTORCYCLE INFORMATION

* Required Field:

Motorcycle mileage at time of new Avon tire installation - numbers only*:


Motorcycle Make*:


Motorcycle Model*:


Motorcycle Year - numbers only*:


TIRE INFORMATION

* Required Field:

Tire Name*:


Tire Size Front (Enter NONE if you only purchased a rear)*:


Tire Size Rear (Enter NONE if you only purchased a front)*:


DOT Number Front (Enter NONE if you only purchased a rear)*:


DOT Number Rear (Enter NONE if you only purchased a front)*:


DOT number is on the sidewall and starts with AT. You must include all letters/numbers including the 4 digits in the oval at the end.:

Date*:


Proof of Purchase (upload scan - 200dpi minimum)*:


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