Need an E-Bike?

Fill out the info below with as much detail as possible. We will review it quickly and will be in touch soon.

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Email

Phone

Country

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How did you hear about us?

What type of bike are you interested in?

If other; what do you have in mind?

Where do you need to go most often?

If other; Where do you need to go most often?

Tell us why

We are considering applicants in the Portland Oregon area that are looking for an alternative transportation option. If you feel that getting to and from school, work, grocery stores, or to medical assistance is a challenge, tell us how this program can help. We want to help people that are already helping themselves. Tell us your story and how we can be a part of it.

Need an E-Bike?

ReviveCycles.Org