Bicycle Registration Form

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.

    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.

Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field