Bicycle Request
If you are 18 years or older and in need of a bicycle and are not in a position to purchase one, please complete the form below. A Bike Walk Nampa representative will review your request and get back to you as soon as possible.

If the need is for someone under 18 years old, please contact us for a different application. All bicycles are refurbished, ready to ride, and come with a support package that includes helmet, front and rear lights, lock, and Smart Cycling safety book. Bike Walk Nampa is a non-profit organization, supported by community donations.

If you have any questions, please contact
LaRita Schandorff
bikewalknampaATgmail.com
208-fOUR ONE TWO-6660

First & last name of person receiving bicycle *
Your answer
Phone Number (or number where you can be contacted) *
Your answer
Who referred you to Bike Walk Nampa? *
Your answer
Tell us your story. Why are you requesting a bicycle? *
Your answer
What is the main purpose for the bike? *
Age *
Gender *
Height (this will help us find a bike that fits you) *
Can you pick up or do you need it to be delivered? *
Delivery info - Address. street, city
Your answer
Best day and time for us to deliver?
Your answer
Do you need any of the following? (mark all that apply)
Any additional information you wish to share?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms