City of Batavia Form Center

2. Bicycle owner's name:*
4. Bicycle owner's date of birth
6. Street Number*
7. Street Name*
8. Street Type*
9. Apt #
11. City*
12. State*
13. ZIP*
15. Phone Number*
16. Email*
18. Bicycle serial or frame number*

    A bicycle's serial or frame number can typically be found under the bottom bracket where the two pedal cranks meet. 

19. Frame type*

    1. Boys/Men
    2. Girls/Women
    3. Unisex
21. Make*
22. Model
24. Model year
25. Color
26. Speeds
28. Tire size
29. Bicycle condition

    1. New
    2. Used
    3. Antique
33. Registration number
35. Reported damage
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field