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Listing Request Form for Bike Wanted

Please PRINT AND SIGN this form and mail it, along with the proper fee, to the address on the bottom of this page.

Please provide the following contact information:
First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail
Please provide the following product information:
Product Name
Model
Product Color
Price Range
Choose one of the following frame condition options:

ANY    FAIR    GOOD    EXCELLENT

Enter any other specific information here:


All bikes listed for sale will be held on the listing until sold or 6 months.  All listings are $10.00 without a picture.  If a picture is included the price is $25.00.  This fee is payable by money order only
No personal checks will be accepted.
Money Order is Payable to: R. Gleason and should be mailed to:
Cyclerecycler
2455 Route 9 North
Howell, NJ 07731

By submitting this application, with the proper fee,  I agree that Cyclerecycler has my permission to publish my name and phone number on the web.  I understand that this request will remain on the web for 6 months.  If I obtain the desired product before the time limit I will advise Cyclerecycler to remove my name.  I understand I will not receive a refund at any time and that Cyclerecycler is not responsible for any contact or transactions that occur between myself and another person because of this ad. This listing is offered only as a service to help individuals find a specific bicycle and does not promote contact between individuals.  All payment will be made by money order only to: R. Gleason.  This printed and signed page will be mailed with the proper fee to Cyclerecycler - 2455 Route 9 North - Howell, NJ 07731.
SIGNED________________________________________________________________DATE_______________________
I DO NOT WANT MY NAME AND NUMBER PUBLISHED.  PLEASE ADVISE ME, BY PERSONAL E MAIL OF INTERESTED PARTIES   SIGNED________________________________________________________DATE________________________
Copyright © 1999 [Cyclerecycler]. All rights reserved.
Revised: May 22, 2006