First Name Last Name Email Address Contact Phone Number

Preferred Bicycle Type Comment in further details if than one class of bike required. Select Electric Mens Raleigh Deluxe Womens Standard Smaller From To Pickup Time Select 8.00am 8.30am 9.00am 9.30am 10.00am 10.30am 11.00am 11.30am 12.00noon 12.30pm 1.00pm 1.30pm 2.00pm 2.30pm 3.00pm 3.30pm 4.00pm 4.30pm 5.00pm

Further Details I accept the hiring terms & conditions Type in letters of above image
(upper or lower case).