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Bicycle Registration Form

Date*
Owner's Name*
Driver's License/ID #*
Local Address*
Local Phone*
Home Address*
Home Phone*
Bicycle Information
Make*
Model*
Style*
Color(s)*
Speeds*
Value*
Serial #*
Characteristics/Accessories*
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*

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Bicycle Registration Form

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