2. Business Name*
4. Business Address
6. City
7. State
8. Zip Code
10. Is this location owned or leased?
11. Type of location: building, lease space, retail, etc.?
12. Location area type?
    -- Select One --UrbanSuburbanRural
14. Business Owner or Applicant Name
16. Phone Number
17. Fax Number
19. Email Address
21. Website
22. Facebook
23. Twitter
24. Instagram
26. Has your company applied for this program previously?
    -- Select One --YesNo
27. If yes, What location?
31. Business Environment

    Please select which of the following apply to your business location

    1. Near Protected Bike Lanes
    2. Near Bike Lanes
    3. Near on-street bike lanes (sharrow)
    4. Near Bike Trails
    5. Near Parks
    6. Access to sidewalks
    7. Near Public Transit Stops
    8. Near Schools
    9. Near Colleges/Universities
    10. Near Other possible Bike Friendly Facilities
33. Please Describe Selected Options
35. Business amenities for riders*

    Please sign to agree that your business will offer free water and allow cyclists to use your restrooms. (Required)

    1. I agree.
37. What other amenities will you offer for cyclist?
39. Electronic Signature
41. Business Goal with Bike Friendly Business :Can you explain your business’s interests in applying for this program?
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field