E-Bike / E-Scooter Registration

Complete the form below. Required fields are marked with *

Resident information

First Name *

Last Name *

Date of Birth *

Phone *

Email *

Service Provider

Address *

City *

State *

ZIP *

Vehicle Type *

Make / Brand *

Model

Serial Number *

Color

I certify the information is correct and I agree to the program rules. *

After submission, staff will review your registration. You may receive an approval/rejection email (if enabled).