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Register to become a Host

Please complete the form below if you are interested in becoming a Host and we will seek out funding to support your application.

First name*

Last name*

Email*

Phone*

Organisation Type*

Name and Nature of Organisation

Address

Country/Region*

Address*

City*

Zip / Postal code*

Council you qualify under*

What would you use the e-cargo bike for?*

Would the e-cargo bike replace another mode of transport - eg van? *

How many hours per week do you think you would use the bike? *

How many days of the week will the bike be free for others? *

Can you list details of other businesses, community groups or resident groups in the area who would use the bike too (the more users the greater the chance that the council will fund the bike)?*

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