Grafe's Free Bike Drive 2006 -2009 Survey

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First name & last name

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Please enter your phone number:

Would you like to trade a cash donation for us giving you advertisingYesNo (you can donate using paypal below)

or fill out this form and it will take you to the home page were there is a donation link towards the bottom of the page. Thank you

Please enter your url : (optional)

Please enter your banner url : (optional)

Can you donate today:

We take any used bikes, motorcycles, parts, helmets, locks, lube, spray paint, tools, & air pumps.

Do you have bikes to donate?YesNo # How many used bikes?

Do you need us to pick them up? (3 minium for pickups)YesNo

Please call with dropoffs to schedule a time. 914-443-2474

Address is: 67 Washington St Middletown N 10940

Please enter the address for pickups:

Please enter the state for pickups:

Please enter the zipcode for pickups:

Do you have bike parts to donate?YesNo

Do you have a motorcycle to donate?YesNo

Do you have some lube to donate?YesNo

Do you have a bike lock to donate?YesNo

Do you have any tools to donate?YesNo

Do you have a air compressor to donate?YesNo

Do you have any helmets to donate?YesNo # How many

Do you have some spray paint to donate?YesNo (we use mostely black and white will take anything) even if dented.

Do you have free storage for us? YesNo

What is the address of the free storage place you are letting us borrow?

Address:

State/Province

Zip code:

Phone Number:

Comment section:

If you want to use your Paypal account to make cash donation

You can use your credit card.

If you have any problems with this form

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Name, Address, Email, Url, Url of a banner online,

How did you hear about this site, Can you make a donation?

Any comments you have.

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