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August 20, 2008
New Member Registration

Before you register, please take a moment to read the rules. By mean of registering, you allready understand and agree all the rules.

All fields below is required except for field with optional mark! We will use all of your information for our administrative purpose only and not for publish to other third party

Login Information
Login Name Your log in name will use as your identity.
Password
Re-type Password
E-mail Address
Customer Name Information
First Name If composing one name, type same name on the both fields.
Last Name
Gender Laki-laki  Perempuan Date of  birth on format "Dd-Mm-Yyyy".
Date of  Birth - -
Religion
Address  1 Please fill your complete address (could be consist of RT/RW, District, Sub-Province)
Address  2  (ops)
Province
Country
City  /  Zip Code / If doesn't now the zip code, input on that field "00000"
Home  Phone  Number Could be your cellphone number.
Office  Phone  Number
Fax  Number  (ops)
Mobile 1
Mobile 2  (ops)
 
  PT. DEWATA HARLEY-DAVIDSON®
Jl. ByPass Ngurah Rai No. 120 A-B, Kuta, Bali 80361 Indonesia
Phone : +62.361-764272,   Fax. : +62.361-764273
webmaster@harley-davidson-bali.com
PT. Dewata Harley-Davidson allright reserved 2007