Bikes for All Client Request Form
This form is for folks who are eligible for the Bikes for All Program. Currently our Bikes for All program is partnered with Church World Services, Water Street Mission, ECHOS, Career Link and BHDS. Clients from these orginizations will be prioritized first.  Before proceeding please ensure the following:
  • You work with a partner agency that will be able to provide the contact information of a caseworker or program manager
  • You are an adult who is not eligible for our other programs
  • You were referred by a partner agency
  • You are seeking transportation for essential needs
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Email *
Client First Name *
Client Last Name *
Date of Birth *
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Race *
Preferred pronouns *
Gender Identity
I identify as one of these marginalized groups: *
Required
Client Current Address
Client Email *
Client Phone Number *
Partner Agency *
Which Common Wheel location would be for you to receive your bicycle and accessories?  
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Name of Social Worker or Program Manager *
Social Worker or Program Manager's email address *
Social Worker or Program Manager's phone number *
Your height
Your weight
What accessories do you need for your bicycle? Please note: we provide a helmet, a u-lock, and a light set. We encourage you to think about what you might need to get to work or to make your commute easier via bicycle
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