Expression of Interest Form

Bike Hire Direct - Partnership Programme

Expression of Interest Form
Full Name *

Title First Name Last Name
Birth Date

Day Month Year
Gender

Address

Address 1
Address 2
Town / City	Department / County
Area Code / Post Code	Country

E-mail *
Phone Number *

- Country Code Phone Number
Mobile Number

- Country Code Phone Number
In what area are you interested in running a Bike Hire Direct business? (you many pick more than one) *

Ain Aisne Allier Alpes de Haute Provence Hautes Alpes Alpes Maritimes Ardèche Ardennes Ariège Aube Aude Aveyron Bouches du Rhône Calvados Cantal Charente Charente Maritime Cher Corrèze Corse du Sud Haute Corse Côte d'Or Côtes d'Armor Creuse Dordogne Doubs Drôme Eure Eure et Loir Finistère Gard Haute Garonne Gers Gironde Hérault Ille et Vilaine Indre Indre et Loire Isère Jura Landes Loir et Cher Loire Haute Loire Loire Atlantique Loiret Lot Lot et Garonne Lozère Maine et Loire Manche Marne Haute Marne Mayenne Meurthe et Moselle Meuse Morbihan Moselle Nièvre Nord Oise Orne Pas de Calais Puy de Dôme Pyrénées Atlantiques Hautes Pyrénées Pyrénées Orientales Bas Rhin Haut Rhin Rhône Haute Saône Saône et Loire Sarthe Savoie Haute Savoie Paris Seine Maritime Seine et Marne Yvelines Deux Sèvres Somme Tarn Tarn et Garonne Var Vaucluse Vendée Vienne Haute Vienne Vosges Yonne Belfort Essonne Hauts de Seine Seine Saint Denis Val de Marne Val d'Oise
When would you like to start your Bike Hire Direct business? *
Why are you interested in a Bike Hire Direct Partnership? *
Who will operate your Bike Hire Direct business? *

You Wife Husband Partner Other Family Friends Business Partner Other (Please state in additional information below)
How did you hear about the Bike Hire Direct Partnership? *
Additional Information
Should be Empty:

Bike Hire Direct - Partnership Programme