top of page
RecoverE Bikes –
Free Ride Program Application
Email
Recoverebikes@gmail.com
Social Media
Apply here
First and Last name
*
Recovery Residence or Facility Name
*
Email
*
Phone
Zip Code
Currently Employed?
Yes
No
Seeking Employment?
Yes
No
N/A
Why are you requesting a free E-Bike Rental code?
To attend treatment
To search for employment
To attend 12step meetings
To go to medical appointments
How often do you expect to use the E-Bike?
Daily
Several times a week
Weekly
Occasionally
Do you agree to inform RecoverE Bikes once you secure employment or personal transportation?
Yes
No
Apply Now
bottom of page
