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2024 Capital Bikeshare Corporate Program Enrollment Form
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* Indicates required question
Email
*
Your email
Company Name
*
Your answer
Where is your organization located?
*
Arlington, VA
Alexandria, VA
City of Fairfax
DC
Fairfax County, VA
Montgomery County, MD
Prince George's County, MD
The City of Falls Church, VA
Check the box to confirm your program level.
*
Full Subsidy (Organization pays $50 per employee, Employee pays $0)
Partial Subsidy - (Organization pays $25 per employee, Employee pays $25 + tax)
University Program - (University pays $0 per student, Student pays $25 + tax)
Required
Address Line 1
*
Your answer
Address Line 2
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
County
*
Your answer
How many employees does your organization have? You must have more than 10 employees to join the program.
*
Your answer
Program Manager Contact Information
This person is the primary contact for the account.
Program Manager Name
*
Your answer
Program Manager Job Title
*
Your answer
Program Manager E-mail
*
Your answer
Program Manager Direct Phone
*
Your answer
Secondary Contact Information
This person is the secondary contact for the account.
Secondary Contact Name
Your answer
Secondary Contact Job Title
Your answer
Secondary Contact E-mail
Your answer
Secondary Contact Direct Phone
Your answer
Accounts Payable Contact Information
This person receives monthly invoices.
Accounts Payable Name
*
Your answer
Accounts Payable Job Title
*
Your answer
Accounts Payable Email
*
Your answer
Accounts Payable Direct Phone
*
Your answer
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