UPlift Black Bike Donation Form
In partnership with Firebird and community donations, UPlift Black has the opportunity to facilitate bicycle donations. Please fill in the info below and watch for email in your spam from Firebird or UPlift Black or phone calls from Firebird.
Clear selection
Name of parent or guardian *
Email *
Preferred phone number for booking appointments *
Is the bike for an adult or child *
If you chose teen or child, what is the age and name of your child
Approximate height of the bike rider *
Any preference of colour or style? *
Do you have a bike to trade in? *
Will you require assistance getting the bicycle home? *
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