Mickey Cohen Motorsports YOUR INFOYour Name(Required)Your Phone(Required)Your Email(Required) Your Shipping Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Shipment Type(Required) One-Way Shipment Bike Swap Choose “One-Way Shipment” if you’re shipping a single motorcycle in one direction. Choose “Bike Swap” if you’re sending a motorcycle to Mickey Cohen Motorsports and receiving a DIFFERENT motorcycle back at your address.This field is hidden when viewing the formMickey Cohen Motorsports Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code ONE-WAY SHIPMENT DETAILSWhich way is your motorcycle moving?(Required) Pickup FROM Mickey Cohen Motorsports Deliver TO Mickey Cohen Motorsports “Pickup FROM Mickey Cohen Motorsports” means your motorcycle is currently at Mickey Cohen Motorsports and needs to come to you. “Deliver TO Mickey Cohen Motorsports” means you’re sending your motorcycle to Mickey Cohen Motorsports.Date Your Vehicle is Available for Pickup(Required) MM slash DD slash YYYY VEHICLE DETAILSMotorcycle Type(Required)Standard MotorcycleTrikes and Over-sizedVIN17-character code, usually found on your title or registration.YearMakeModelHeight, Width, LengthWindshield? Yes No Helps our drivers secure your bike properly.Estimated ValueIncrease Shipment Valuation Over $15,000?(Required) Yes No Your shipment is automatically covered up to $15,000 — this option is only needed if your motorcycle is worth more than that. Fee: $35 per $5,000 of increased valuation, per unit, per trip.Additional Insurance Value(Required)$0 – $14,999$15,000 – $19,999$20,000 – $24,999$25,000 – $29,999$30,000 – $34,999$35,000 – $39,999$40,000 – $44,999$45,000 – $49,999$50,000 – $54,999$55,000 – $59,999$60,000 – $64,999$65,000 – $69,999$70,000 – $74,999$75,000 – $79,999$80,000 – $84,999$85,000 – $89,999$90,000 – $94,999$95,000 – $99,999Optional No-Deductible Insurance(Required) Yes No If your motorcycle is damaged in transit, a $500 deductible applies — select Yes to remove that deductible for a $50 fee.ROUND TRIP / BIKE SWAP DETAILSWhich happens first?(Required) Ship my unit to Mickey Cohen Motorsports first Receive my new unit from Mickey Cohen Motorsports first Let us know which leg of your swap should happen first — this just tells us which date to lock in now. The other leg will be scheduled once it’s ready, no need to know that date yet.Date Your Unit is Available for Pickup(Required) MM slash DD slash YYYY Your new unit’s delivery will be scheduled separately once it’s ready.UNIT YOU'RE SENDINGMotorcycle Type (Unit You're Sending)(Required)Standard MotorcycleTrikes and Over-sizedVIN17-character code, usually found on your title or registration.YearMakeModelHeight, Width, LengthWindshield? Yes No Helps our drivers secure your bike properly.Estimated ValueIncrease Shipment Valuation Over $15,000?(Required) Yes No Your shipment is automatically covered up to $15,000 — this option is only needed if your motorcycle is worth more than that. Fee: $35 per $5,000 of increased valuation, per unit, per trip.Additional Insurance Value(Required)$0 – $14,999$15,000 – $19,999$20,000 – $24,999$25,000 – $29,999$30,000 – $34,999$35,000 – $39,999$40,000 – $44,999$45,000 – $49,999$50,000 – $54,999$55,000 – $59,999$60,000 – $64,999$65,000 – $69,999$70,000 – $74,999$75,000 – $79,999$80,000 – $84,999$85,000 – $89,999$90,000 – $94,999$95,000 – $99,999Optional No-Deductible Insurance(Required) Yes No If your motorcycle is damaged in transit, a $500 deductible applies — select Yes to remove that deductible for a $50 fee.UNIT YOU'RE RECEIVINGIf you don’t have these details yet, that’s okay — leave them blank and our team will follow up with you before the return shipment goes out.Motorcycle Type (Unit You're Receiving)(Required)Standard MotorcycleTrikes and Over-sizedVIN17-character code, usually found on your title or registration.YearMakeModelHeight, Width, LengthWindshield? Yes No Helps our drivers secure your bike properly.Estimated ValueIncrease Shipment Valuation Over $15,000?(Required) Yes No Your shipment is automatically covered up to $15,000 — this option is only needed if your replacement motorcycle is worth more than that. Not sure yet? Select No for now — you can flag changes in the Additional Information section below. Fee: $35 per $5,000 of increased valuation, per unit, per trip.Additional Insurance Value(Required)$0 – $14,999$15,000 – $19,999$20,000 – $24,999$25,000 – $29,999$30,000 – $34,999$35,000 – $39,999$40,000 – $44,999$45,000 – $49,999$50,000 – $54,999$55,000 – $59,999$60,000 – $64,999$65,000 – $69,999$70,000 – $74,999$75,000 – $79,999$80,000 – $84,999$85,000 – $89,999$90,000 – $94,999$95,000 – $99,999Optional No-Deductible Insurance(Required) Yes No If your motorcycle is damaged in transit, a $500 deductible applies — select Yes to remove that deductible for a $50 fee.ADDITIONAL INFORMATIONAny Additional InformationBILLINGBilling Address(Required) Same as Shipping Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Shipping Terms and Conditions(Required) I agree to the Shipping Terms and Conditions.Privacy Policy(Required) I agree to the Privacy Policy.TOTALFuel Surcharge(Required) $0.00 State Surcharge Price: Additional surcharge applies for remote or hard-to-service states based on your location.Maine – State Surcharge Price: Additional surcharge applies based on your location.NYC – Surcharge Price: Additional surcharge applies based on your location.Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Questions? – Contact Us
