Lend your eBike to a Healthcare Worker
Thanks for your generosity. Please fill out this form.
We will contact you soon to collect your eBike, service it and arrange to lend it to a healthcare worker.
No need to give us a lock, we will provide high security locks. However, if your lock is secure enough, it will be useful to have too.

We will arrange the return of your eBike when it's safe for healthcare workers to use public transport again.
Or we can arrange the return anytime you ask us.
Email address *
First name *
Your answer
Last name *
Your answer
Company (if applicable)
Your answer
Mobile number *
Your answer
Number of eBikes *
eBike Brand/s and Model/s. (Must be a 25km/h 250w limited pedelec without throttle) *
Your answer
Collection Address *
Your answer
Preferred collection times (we will call to confirm) *
eBike Frame Number/s *
Your answer
How to find your Frame Number
Submit
Never submit passwords through Google Forms.
This form was created inside of ycompany.co. Report Abuse