2. First Name*
3. Last Name*
5. Address1*
7. City
8. State
9. Zip
11. Contact Number*
12. email
14. Manufacturers Serial Number*
16. Bicycle Make*
17. New or Used Bicycle

    1. New
    2. Used
19. Frame Color*
20. Frame Type*
    -- Select One --Double Bar FrameSignle Bar FrameOther
22. Bicycle Model
23. Boys or Girls Style Bike

    1. Boys Style
    2. Girls Style
25. Brakes

    1. Front
    2. Rear
    3. Front and Rear
    4. Coaster Bike
26. Wheel Size*
    -- Select One --16 Inch18 Inch20 Inch21 Inch 24 Inch26 Inch 27 Inch 28 Inch
28. Seat Make
29. My bike has

    1. Front Fender
    2. Rear Fender
31. Rim Color
32. Fender Color
34. Accessories

    1. Front Light
    2. Rear Light
    3. Locking Device
    4. Reflectors
    5. Front Basket
    6. Rear Basket
35. Describe any other accessories
37. Distinguishing Characteristics about the bike (please be detailed)
39. Please Note:
    Florida has a very broad public records law. Most written communications to or from the Town of Jupiter officials and employees regarding public business are public records available to the public and media upon request. Your e-mail communications may be subject to public disclosure. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.
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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field