Indian Motorcycle Order Form    <div id="content">
        <div class="text">

            
            <form name="openleads" method="post" action="">
                <table width="100%" border="0" cellspacing="0" cellpadding="5">
                    <tr><td colspan="2">Please fill out the fields below and tell us what 2009 Chief we will build for you. If you need some help with your decision or have questions about options, please refer to the spec sheets for each model, which can be downloaded from The Motorcycles section of our website or contact Indian Motorcycle Charlotte at 704-879-4560.</td></tr>
                    <tr>
                        <td class="fields">
                            <label for="first">First Name <span class="required">*</span></label>
                        </td>
                        <td>
                            <input type="text" size="40" maxlength="200" id="first" name="first" value="" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="last">Last Name <span class="required">*</span></label>
                        </td>
                        <td>
                            <input type="text" size="40" maxlength="200" id="last" name="last" value="" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="phone">Phone <span class="required">*</span></label>
                        </td>
                        <td>
                            <input type="text" size="40" maxlength="200" id="phone" name="phone" value="" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="email">Email <span class="required">*</span></label>
                        </td>
                        <td>
                            <input type="text" size="40" maxlength="200" id="email" name="email" value="" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="address">Address <span class="required">*</span></label>
                        </td>
                        <td>
                            <input type="text" size="40" maxlength="200" id="address" name="address" value="" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="city">City <span class="required">*</span></label>
                        </td>
                        <td>
                            <input type="text" size="40" maxlength="200" id="city" name="city" value="" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="country">Country</label>
                        </td>
                        <td>
                            <input type="text" size="40" maxlength="200" id="country" name="country" value="" />
                            
                        </td>
                    </tr>
                    <tr><td colspan="2">Please select your motorcycle and options:</td></tr>
                    <tr>
                        <td class="fields">
                            <label for="f6241">Chief Standard - $30,999</label>
                        </td>
                        <td>
                            <input type="checkbox" id="f6241" name="f6241" value="1" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6242">Standard Paint</label>
                        </td>
                        <td>
                            <select id="f6242" name="f6242">
                                <option value=""></option>
                                <option value="Thunder Black with Silver Script">Thunder Black with Silver Script</option>
                                <option value="Thunder Black with Silver Head Dress">Thunder Black with Silver Head Dress</option>
                                <option value="Indian Red with Gold Script (+ $199)">Indian Red with Gold Script (+ $199)</option>
                                <option value="Indian Red with Gold Head Dress (+ $199)">Indian Red with Gold Head Dress (+ $199)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6243">Standard Fender</label>
                        </td>
                        <td>
                            <select id="f6243" name="f6243">
                                <option value=""></option>
                                <option value="Short">Short</option>
                                <option value="Long (+ $499)">Long (+ $499)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6244">Standard Wheels</label>
                        </td>
                        <td>
                            <select id="f6244" name="f6244">
                                <option value=""></option>
                                <option value="Laced">Laced</option>
                                <option value="Billet (+ $999)">Billet (+ $999)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6268">Standard Tires</label>
                        </td>
                        <td>
                            <select id="f6268" name="f6268">
                                <option value=""></option>
                                <option value="Black Wall">Black Wall</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6246">Standard Leather</label>
                        </td>
                        <td>
                            <select id="f6246" name="f6246">
                                <option value=""></option>
                                <option value="Black">Black</option>
                                <option value="Tan (+ $99)">Tan (+ $99)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6247">Chief Deluxe - $31,999</label>
                        </td>
                        <td>
                            <input type="checkbox" id="f6247" name="f6247" value="1" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6248">Deluxe Paint</label>
                        </td>
                        <td>
                            <select id="f6248" name="f6248">
                                <option value=""></option>
                                <option value="Thunder Black with Silver Script">Thunder Black with Silver Script</option>
                                <option value="Thunder Black with Silver Head Dress">Thunder Black with Silver Head Dress</option>
                                <option value="Indian Red with Gold Script (+ $199)">Indian Red with Gold Script (+ $199)</option>
                                <option value="Indian Red with Gold Head Dress (+ $199)">Indian Red with Gold Head Dress (+ $199)</option>
                                <option value="Thunder Black &amp; Winter White with Silver Script (+ $899)">Thunder Black &amp; Winter White with Silver Script (+ $899)</option>
                                <option value="Midnight Blue Metallic &amp; Winter White with Silver Head Dress (+ $899)">Midnight Blue Metallic &amp; Winter White with Silver Head Dress (+ $899)</option>
                                <option value="Thunder Black &amp; Indian Red with Gold Head Dress (+ $899)">Thunder Black &amp; Indian Red with Gold Head Dress (+ $899)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6257">Deluxe Fender</label>
                        </td>
                        <td>
                            <select id="f6257" name="f6257">
                                <option value=""></option>
                                <option value="Short">Short</option>
                                <option value="Long (+ $499)">Long (+ $499)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6260">Deluxe Wheels</label>
                        </td>
                        <td>
                            <select id="f6260" name="f6260">
                                <option value=""></option>
                                <option value="Laced">Laced</option>
                                <option value="Billet (+ $999)">Billet (+ $999)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6245">Deluxe Tires</label>
                        </td>
                        <td>
                            <select id="f6245" name="f6245">
                                <option value=""></option>
                                <option value="Black Wall">Black Wall</option>
                                <option value="White Wall (+ $99)">White Wall (+ $99)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6250">Deluxe Leather Color</label>
                        </td>
                        <td>
                            <select id="f6250" name="f6250">
                                <option value=""></option>
                                <option value="Black">Black</option>
                                <option value="Tan (+ $99)">Tan (+ $99)</option>
                                <option value="Red(+ $99)">Red(+ $99)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6263">Deluxe Fringe</label>
                        </td>
                        <td>
                            <select id="f6263" name="f6263">
                                <option value=""></option>
                                <option value="No">No</option>
                                <option value="Yes (+ $99)">Yes (+ $99)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6251">Chief Roadmaster - $33,999</label>
                        </td>
                        <td>
                            <input type="checkbox" id="f6251" name="f6251" value="1" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6252">Roadmaster Paint</label>
                        </td>
                        <td>
                            <select id="f6252" name="f6252">
                                <option value=""></option>
                                <option value="Thunder Black with Silver Script">Thunder Black with Silver Script</option>
                                <option value="Thunder Black with Silver Head Dress">Thunder Black with Silver Head Dress</option>
                                <option value="Indian Red with Gold Script (+ $199)">Indian Red with Gold Script (+ $199)</option>
                                <option value="Indian Red with Gold Head Dress (+ $199)">Indian Red with Gold Head Dress (+ $199)</option>
                                <option value="Thunder Black &amp; Winter White with Silver Script (+ $899)">Thunder Black &amp; Winter White with Silver Script (+ $899)</option>
                                <option value="Midnight Blue Metallic &amp; Winter White with Silver Head Dress (+ $899)">Midnight Blue Metallic &amp; Winter White with Silver Head Dress (+ $899)</option>
                                <option value="Thunder Black &amp; Indian Red with Gold Head Dress (+ $899)">Thunder Black &amp; Indian Red with Gold Head Dress (+ $899)</option>
                                <option value="Smoke Silver Metallic &amp; Winter White with Silver Head Dress (+ $899)">Smoke Silver Metallic &amp; Winter White with Silver Head Dress (+ $899)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6258">Roadmaster Fender</label>
                        </td>
                        <td>
                            <select id="f6258" name="f6258">
                                <option value=""></option>
                                <option value="Short">Short</option>
                                <option value="Long (+ $499)">Long (+ $499)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6261">Roadmaster Wheels</label>
                        </td>
                        <td>
                            <select id="f6261" name="f6261">
                                <option value=""></option>
                                <option value="Laced">Laced</option>
                                <option value="Billet (+ $999)">Billet (+ $999)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6259">Roadmaster Tires</label>
                        </td>
                        <td>
                            <select id="f6259" name="f6259">
                                <option value=""></option>
                                <option value="Black Wall">Black Wall</option>
                                <option value="White Wall (+ $99)">White Wall (+ $99)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6276">Roadmaster Windshield</label>
                        </td>
                        <td>
                            <select id="f6276" name="f6276">
                                <option value=""></option>
                                <option value="Yes">Yes</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6272">Roadmaster Seat</label>
                        </td>
                        <td>
                            <select id="f6272" name="f6272">
                                <option value=""></option>
                                <option value="Two Up">Two Up</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6265">Roadmaster Leather Color</label>
                        </td>
                        <td>
                            <select id="f6265" name="f6265">
                                <option value=""></option>
                                <option value="Black">Black</option>
                                <option value="Tan (+ $99)">Tan (+ $99)</option>
                                <option value="Red (+ $99)">Red (+ $99)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6264">Roadmaster Fringe</label>
                        </td>
                        <td>
                            <select id="f6264" name="f6264">
                                <option value=""></option>
                                <option value="No">No</option>
                                <option value="Yes (+ $99)">Yes (+ $99)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6254">Chief Vintage - $35,999</label>
                        </td>
                        <td>
                            <input type="checkbox" id="f6254" name="f6254" value="1" />
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6256">Vintage Paint</label>
                        </td>
                        <td>
                            <select id="f6256" name="f6256">
                                <option value=""></option>
                                <option value="Thunder Black">Thunder Black</option>
                                <option value="Indian Red (+ $199)">Indian Red (+ $199)</option>
                                <option value="Ivory Cream (+ $199)">Ivory Cream (+ $199)</option>
                                <option value="Thunder Black &amp; Indian Red (+ $899)">Thunder Black &amp; Indian Red (+ $899)</option>
                                <option value="Willow Green &amp; Ivory Cream (+ $899)">Willow Green &amp; Ivory Cream (+ $899)</option>
                                <option value="Indian Red &amp; Ivory Cream (+ $899)">Indian Red &amp; Ivory Cream (+ $899)</option>
                                <option value="Arizona Turquoise &amp; Winter White (+ $899)">Arizona Turquoise &amp; Winter White (+ $899)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6255">Vintage Fender</label>
                        </td>
                        <td>
                            <select id="f6255" name="f6255">
                                <option value=""></option>
                                <option value="Long">Long</option>
                                <option value="Short">Short</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6262">Vintage Wheels</label>
                        </td>
                        <td>
                            <select id="f6262" name="f6262">
                                <option value=""></option>
                                <option value="Laced">Laced</option>
                                <option value="Billet (+ $999)">Billet (+ $999)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6269">Vintage Tires</label>
                        </td>
                        <td>
                            <select id="f6269" name="f6269">
                                <option value=""></option>
                                <option value="White Wall">White Wall</option>
                                <option value="Black Wall">Black Wall</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6279">Vintage Windshield</label>
                        </td>
                        <td>
                            <select id="f6279" name="f6279">
                                <option value=""></option>
                                <option value="Yes">Yes</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6266">Vintage Leather Color</label>
                        </td>
                        <td>
                            <select id="f6266" name="f6266">
                                <option value=""></option>
                                <option value="Black">Black</option>
                                <option value="Tan (+ $99)">Tan (+ $99)</option>
                                <option value="Red (+ $99)">Red (+ $99)</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr>
                        <td class="fields">
                            <label for="f6280">Vintage Fringe</label>
                        </td>
                        <td>
                            <select id="f6280" name="f6280">
                                <option value=""></option>
                                <option value="Yes">Yes</option>
                            </select>
                            
                        </td>
                    </tr>
                    <tr><td colspan="2">We realize you may have questions about your order. Please contact Indian Motorcycle Charlotte at 704-879-4560 and speak to the sales department and they will be happy to walk you through the purchasing process. Or you can enter any questions in the box below and we will respond as quickly as possible.</td></tr>
                    <tr>
                        <td class="fields">
                            <label for="f6299">Questions</label>
                        </td>
                        <td>
                            <textarea id="f6299" name="f6299" cols="50" rows="10"></textarea>
                            
                        </td>
                    </tr>
                    <tr><td colspan="2">Here is where the dream becomes a reality. When you click the Send button below, your 2009 Chief will officially be added to our production schedule. You will receive an email shortly confirming we have received your order. If you have any problems with this form, please contact mark@indianmotorcyclecharlotte.com.

We look forward to building your bike.</td></tr>
                        <tr><td class="fields">&nbsp;</td><td><input type="submit" class="button" name="send" value="Send" /></td></tr>
                </table>
            </form>
            <span class="required">*</span> required field
        </div>
    </div>
Indian Motorcycle Order Form