Bike Rack Installation Request

2. Contact Information

4. Name:*

6. Phone Number:*

8. Email Address:*

12. Bike Rack Placement Information

14. Type of Location *
    -- Select One --PublicPrivate

    *Racks installed on a public right-of-way will be installed at no cost. Racks installed on private property require a payment of $148 for the first rack and $103 for each additional rack.

15. Name of Business/Establishment*

17. Address of Placement:*

18. Zip

20. Relationship to Establishment:
    -- Select One --OwnerCustomer/ResidentEmployeeOther

22. Please provide a detailed description of the desired placement for each rack

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field