Reservation Form

Personal information

I am:

an individual
an organisation

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Organisation:

VAT-number:

Name and First Name:

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Street & number:

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Postal code:

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City:

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Country:

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Telephone:

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E-mail adresse:

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National number:

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Period

I would like to rent a bike on

Start:

(dd/mm/yyyy)

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Time:

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End:

(dd/mm/yyyy)

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Time:

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Articles

I would like to rent the following amount of bikes

Citybike Male:

Citybike Female:

Bike bag:

Bike for a boy:

Bike for a girl:

Seat for children:

Third wheel:

Bike trailer:

Bike with low step-in:

Electric Bike:

Folding Bike:

Travel Bike Gents:

Travel Bike Ladies:

Travel Bags:

MTB:

Tandem:

Tandemtransporter:

Kickbike:

Recumbent bike:

Bike with wheelchair:

Handbike:

Rikshaw:

Rikshaw Purple (type bakfiets)
Rikshaw Red (type sidecar)
Riksshaw Orange (type Indian)
Rikshaw White (type sidecar)
Rikshaw Broel (type Indonesian)
Riksjhaw Indo (type indonesian)

Remarks:

Transport (till 90 bikes at â‚¬ 1,00/km with a forfait of â‚¬ 25,00 a ride)

Mobiel should deliver the bikes on a special location:

ja
neen

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Adresse:

Postal code:

City:

Country:

Adress for picking up again:

Postal code:

City:

Country:

Contact person a the location:

Telephone:

I've read the renting conditions:

ja

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Remarks: