Bike Registration (Demo) Owner InformationName First Last PhoneDate of Birth Month Day Year Email Home Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Bike InformationBrand Model Color # of Speeds Date of Purchase MM slash DD slash YYYY Serial # Other Bicycle CharacteristicsBicycle ReceiptMax. file size: 128 MB.Bicycle PhotoMax. file size: 128 MB.Declare By signing below, I declare under penalty of perjury that I am over 18 years of age and all above information is correct and I am the legal owner of this bicycle. Signature
