By providing personally identifiable information, such as your name and contact information (“Information”) on this form, you consent to the collection and use of the Information by any of Fred Deeley Imports Ltd., dba Deeley Harley-Davidson® Canada, its Retailers, Harley-Davidson Motor Company Inc. and Harley-Davidson Owners Group® of Canada Ltd., for marketing and research purposes or to send you Harley-Davidson®/Buell® branded products, programs and services information.

If, at a later date, you would prefer that we not continue to use the Information for the purposes set out above, please fax your request to 604-273-2029, Attention: Privacy Officer. You may view the Deeley Harley-Davidson Canada Privacy Policy on our website.

*I consent to such use by Deeley Harley-Davidson® Canada.