Cyclescheme Certificate of Acceptance

This form must be printed, completed by the participant and signed.

Then posted to:

Mailorderbikes.com Cyclescheme
Raleigh Cycle Centre
38-42 Kingston Broadway
Shoreham By Sea
West Sussex
BN43 6TE

CYCLE SCHEME CERTIFICATE OF ACCEPTANCE

PARTNER STORE DETAILS:

PARTNER STORE NAME: MAILORDERBIKES.com
PARTNER STORE ADDRESS:
Raleigh Cycle Centre
38-42 Kingston Broadway
Shoreham By Sea
West Sussex
BN43 6TE
Telephone number: 01273 596368



Participant Details:

Your Name:_______________________________________


Your Address:______________________________________


___________________________________________________


___________________________________________________


___________________________________________________


Your telephone number:____________________________


Bike Details


Bike Make:_________________________________________


Bike Model:_________________________________________


Bike Size:___________________________________________


Bike Frame Number:_________________________________
(please note this is usually stamped into the frame beneath the bottom bracket, this is the underside of the bicycle where the pedals go into the frame)


Bike Price:__________________________________________


Safety Equipment Details:


PRODUCT PRICE
____________________________________________________


____________________________________________________


____________________________________________________


____________________________________________________


____________________________________________________


____________________________________________________


____________________________________________________


____________________________________________________


DECLARATION: I have received the above listed goods in good condition.



Participant's Signature________________________________


Date:________________________________________________


Print Name:__________________________________________