BIKE BANK APPLICATION

Our intention is to get bikes to those who need them but who for whatever reasons may not be able to afford one right now. We began distributing our refurbished bikes in early May. If you would like to apply for a bike, please fill out the application found below.

The Bike Bank has a limited number of bikes and it may not be possible to fulfill all requests.

Recipient Information

* First Name

* Last Name

* Email Address

Phone Number

* Address

* City

Details

* Your height

* Helmet Size

* Bike Type

Age (if selecting a Child's bike)

* Bike Gender

Additional Information

Please indicate here any special features you require. For example: a bike with a coaster brake or a simple bike with no or few gears.

Special features

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