Sunday, May 19, 2013
Home
About Us
Testimonials
Investment
Products
Earn-A-Bike
Video
Contact
Order Online
Donate
Print Order
Print Order
Login
Register
You may print this order form and price list
or submit your rider's specifications online below.
Adobe® Reader required. Click the Adobe Logo to download and install the free Adobe® Reader.
Your Cart
Item(s):
0
Total Price:
$0.00
VIEW CART
Submit Your Custom Specifications
ORDER FORM & SPECIFICATIONS FOR CUSTOMIZED CYCLES
*
INDICATES REQUIRED FIELD
Date
Parents or Guardians
Rider Name
*
Street Address
*
City
*
State
*
Zip
*
Shipping Name if Different From Above
Shipping Address if Different Than Above
Shipping Address 2
City to Ship to
State to Ship to
Ship to Zip Code
Home Phone
*
Cell Phone
Your Email Address
*
Best Time to Call
RIDER DATA AND MEASUREMENTS:
Age
*
Height
*
Weight
*
Measurement #3 Armpit to Center of Palm in Inches
*
(See Diagram B)
Measurement #4 Seat of Chair to Shoulder in Inches
*
(See Diagram A)
Measurement #5 Back of Seat to Back of Calf
*
(See Diagram A, in inches, measure back of seat to back of calf
at bend
of knee while seated)
Measurement #6 Under Knee to Sole of Shoe
*
(See Diagram A, in inches, under bend of knee to sole of shoe while seated)
Measurement #7 Across Back of Hips While Seated
*
(See Diagram C, measure at chair seat level while seated)
Measurement #8 Inseam Crotch to Sole of Shoe
*
(See Diagram B, measure crotch to sole while standing or laying)
Rear Drive Choice:
*
3 Speed
1 Speed
Direct Drive
Does the Seat Need a Back?
*
Yes
No
Does Seat Need Armrests?
*
Yes
No
Does Rider Need Chest Strap?
*
Yes
No
If Yes, Measure Around Chest in Inches
Does Rider Need a Lap Belt?
*
Yes
No
If Yes, Measure Around Body While Seated (Diagram A)
Does Rider Need Foot Pedals or Footboard?
*
Foot Pedals
Foot Board
Does Rider Need Foot Straps on Pedals or Footboard?
*
Yes
No
Does Rider Need Heel Straps?
*
Yes
No
Does Rider Want a Basket?
*
Yes
No
What Color Frame Does Rider Want?
*
Red
Blue
Measure Around Head for Helmet 1" Above Ears
*
Describe What Rider Can Do (Arms and Legs):
*
Describe What Rider Can Not Do (Arms and Legs)
*
Enter Captcha Value:
*
Submit
Copyright 2012 by eWorldServices.com: Rock and Roll Cycles, LLC
Terms Of Use
Privacy Statement