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BICYCLE REGISTRATION FORM
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BICYCLE REGISTRATION FORM
NOTE:
The City of Fairbury is only able to register bicycles for City of Fairbury residents
Instructions:
Complete the form, submit and/or print (if unable to print, the City Clerk's Office can print a copy for you)
Bring printed copy to the City Clerk's Office, City of Fairbury office (612 D Street, Fairbury, NE)
Pay the registration fee of $3.00
First Name
*
Last Name
*
Email Address
Street Address
*
City, State, Zip Code
*
Phone Number
*
Type of Phone
-- Select One --
Home
Work
Mobile
Alternate Phone Number
Type of Phone
-- Select One --
Home
Work
Mobile
BICYCLE DESCRIPTION
Select Bicycle Style
*
-- Select One --
BMX
Cruiser
Hybrid
Mountain Bike
Recumbent
Road/Touring
Tandem
Tricycle
Other
Select Frame Type
*
-- Select One --
Men's
Women's
Bicycle Primary Color
*
Bicycle Secondary Color
*
Number of Speeds
*
Bicycle Tire Size
*
Please describe additional information about handlebars, extensions, tape, grips, etc (color/material)
Upload a file or picture
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