ALL ABILITIES BIKE INCLUSIVE LEARN-TO-RIDE PROGRAM APPLICATION

"*" indicates required fields

Legal Name of Organization*

Organization Phone*

Mailing Street Address*

Address Line 2

City*

State*

Postal / ZIP Code*

Name*

ORGANIZATION INFORMATION

Estimated number of individuals that will learn how to ride a bike annually*

Check 'yes' if requesting a standard fleet of (10) 20-inch bikes *The program has a one time cost of $5,500.00

Yes

If not requesting a standard fleet, please specify the number of 14-inch bikes you will be needing

14 inch bike quantities available: 1, 2, 3, 4 or 5. The rest of your fleet will be made up of 20-inch bikes.

Where did you hear about All Abilities Bike?*

Would you like to receive our newsletters?*

Yes

Invoicing Information*

Yes

Social Permission*

Yes

Do we have permission to share on All Abilities Bike social media pages?

Social Media Links (if applicable)

Please upload your school/organizations W9

Proof of 501(c)(3) or Government Entity Status*

Max. file size: 8 MB.

Type Name of Applicant*

Signature*

Signature of Applicant

This field is for validation purposes and should be left unchanged.