SEAI Bike Library Sign-Up Form

Bike Library

Sign-Up Form
Borrow an e-bike and accessories free for 4 months and experience how cycling can fit into your daily routine. Whether you're commuting to work, doing the school run, or running errands, the Bike Library gives you a chance to try out a practical, low-cost alternative to car travel. There’s no rental fee involved, just a fully refundable deposit which is returned to you at the end of the loan period.
Bike Number
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Work Email Address*
Workplace email
Home Address*

Street Address

Street Address Line 2

CityState / Province

Eircode
Company Name *
Team/Discipline *
Are you a red carpark badge holder?*

YesNo
Team*
Department*
Department
Other (please specify)
Q1.) What is your current mode of transport?*

CarPublic TransportWalkingCyclingOther....
Q1. Other
Q2.)What type of bicycle storage space do you have in your home?(Select all that apply)*

Secure Shed/GarageSecure Back GardenUnsecure Back GardenUnsecure Front GardenIndoor Storage, e.g HallwayOther...
Q2. Other
Q3.)What type of bicycle storage space do you have in your workplace? (If applicable)

Secure Cycle Parking Facility (Keycard/Key access)Cycle Parking Stands (Public area, e.g. surface car park)Indoor Storage, e.g. Inside an officeNoneOther....
Q3. Other
Q4.)How far do you live from your place of work?*

Within 2km2km-5km5km-10km10km+
Q5.) Do you have any children?*

YesNo
Q5.1) How many children do you plan to transport on the ebike/ecargo bike?*

0 (I will cycle alongside my child).123

Q5.3) Do you require a child seat, max weight limited (22kg)?*

YesNo
Q6.) What type of bike would you prefer to borrow? (We cannot guarantee that you will receive your first preference, and the exact model may not match the pictures shown below.) *
2nd Preference?*
Should be Empty:

Rows	Under 2yrs	2-5yrs	5+yrs
Child 1
Child 2
Child 3
Child 4