DG Custom Seat Danny Gray Custom Build Seat Intake Form Date MM slash DD slash YYYY Name First Last Email PhoneBilling Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Shipping Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country WHAT IS THE MAKE OF THE MOTORCYCLE YOU RIDE?* Harley Davidson Other Other MakeYear*20172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983 and earlierHARLEY DAVIDSONWHAT FAMILY DOES YOUR MOTORCYCLE BELONG TO?SportsterDynaSoftailTouringOtherOtherSPORTSTERWHAT IS THE MODEL OF YOUR SPORTSTER?*Roadster (CX 1200R)1200 Custom (XL 1200C)Forty Eight (48) (XL 1200X)Custom (XL C)OtherSPORTSTER MODELS:WHAT IS THE YEAR OF YOUR SPORTSTER?2004-PresentOlder than 2004SPORTSTER C/RDYNAWHAT IS THE MODEL OF YOUR DYNA?Street Bob (FXDB)Wide Glide (FXDWG)Low Rider (FXDL)SuperFat Bob (FXDF)OtherOTHERWHAT IS THE YEAR OF YOUR DYNA?2006-PresentBefore 20062004-2005Before 2004SUPERWIDE GLIDENon-WIDE GLIDE/SUPERSOFTAILWHAT IS THE MODEL OF YOUR SOFTAIL?Slim (FLS)Slim S (FLSS)Deuce ( )Blackline ( )Heritage Classic (FLSTC)Deluxe (FLSTN)Breakout (FXSBRocker ( )Springer (FXSTSSE3)Screamin’ Eagle Softail Springer (FXSTSSE2)OtherOtherWHAT IS THE YEAR OF YOUR SOFTAIL?2017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984Before 1984TOURINGWhat is the MODEL of your TOURING?Road King (FLHR)Street Glide (FLHX)Street Glide Special (FLHXS)Road Glide (FLTRRoad Glide Ultra (FLTRXU)Electra Glide Standard (FLHT)Electra Glide Ultra Classic (FLHTCU)Ultra Limited (FLHTKU)Ultra Limited Low (FLHTKUL)OtherOtherWhat is the YEAR of your TOURING?‘08 - Present2006-20071997 - 2006Before ‘97ROAD KING (FLHR)OTHEROtherSTEP 1: Chose a Solo or 2up Seat Model:ARE YOU LOOKING FOR A SOLO OR 2-UP?Solo2-UPSolo Seat ModelsButtcrack SoloWeekday SoloSpeed Cradle SoloRocker (Weekday Solo or Speed Cradle)Big SeatAirHawk Big SeatBig Seat w/ Backrest ReceptacleAirHawk Big Seat w/ Backrest ReceptacleBackrest (Small or LARGE)Integrated Pillion Pad (Medium or Large)Integrated Pillion Pad Extra LargeAirhawk Integrated Pillion Pad Extra Large2-Up Seat ModelsShorthop 2upShorthop 2upXLWeekday 2upWeekday 2upXLWeekday 2upXL w/Driver backrest receiverAirHawk Weekday 2upXLAirHawk Weekday 2upXL w/Driver Backrest ReceiverAirHawk LongHaul 2upXLAirHawk LongHaul 2upXL w/Driver Backrest ReceptacleBackrest (Small or Large)Step 2: Choose Custom Personalize OptionsUpgraded Leather $ market price Yes No Stitch Pattern /Thread Color:* Driver Area Passenger Area No Embossed Leather Inlay:* Driver Area Passenger Area No Exotic Leather Inlay:* Driver Area (market $) Passenger Area (market $) No Gel:* Driver Area Passenger Area No AIRHAWK:* Driver Area Passenger Area No Backrest Driver Receiver -Custom added* Yes No Modification of Foam* Yes No Notes:CUSTOM FITTING QUESTIONSFROM STOCK SEAT LOCATION, WOULD YOU LIKE TO ADJUST THE DISTANCE OF YOUR SEAT IN RELATION TO THE HANDLEBARS?No, I’m fine with the current locationYes, please move me forward!Yes, please move me back 1”!Yes, please move me back 2”!WHAT IS THE NATURE OF YOUR DISCOMFORT?Seat is too hard!My tailbone/lower back hurts!The pressure points of my bottom are hurting!My body is cramping/my whole body feels sore after I ride.No discomfort, just customizing my seat.(FORWARD/SAME): WHAT IS THE NATURE OF YOUR DISCOMFORT?Seat is too hard!My tailbone/lower back hurts!The pressure points of my bottom are hurting!My body is cramping/my whole body feels sore after I ride.No discomfort, just customizing my seat.(BACK 1”): WHAT IS THE NATURE OF YOUR DISCOMFORT?Seat is too hard!My tailbone/lower back hurts!The pressure points of my bottom are hurtingMy body is cramping/my whole body feels sore after I ride.No discomfort, just customizing my seat.(BACK 2”): HOW OFTEN WILL YOU HAVE A PASSENGER RIDING WITH YOU?Seldom (5%-25%)Sometimes (25%-50%)Often (50%-100%)Your HEIGHT and WEIGHT*Payment Type: Visa Master Card American Express Discover Credit Card Number:Expiration Date: MM slash DD slash YYYY CVV Code:Upload File with your bike and your sitting on the bike, for better fitmentMax. file size: 50 MB.Once you provide contact information, we'll contact you within 24 hours (excluding weekends and holidays) for additional info. You are purchasing a “custom made to order” seat that is not a stocked item. Lead time generally is 3-4 weeks to ship from date order and quotes is finalized and you will sign off on design. Finalized quotes on custom seat design from 7-10 business days. Promised Ship Date: 30 business days after customer signed off on custom seat order 30 day exchange on standard seats. Personalized, modified or standard seats with upgraded options not exchangeable or refundable. Custom items non-refundable. 1 yr full warranty for mfg defect(s).CAPTCHA Δ