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Please fill in your details and requirements

Mr. Mrs. Miss

Surname*
First name*
Company
E-mail*
Street
Postcode
Town/City
Country
Telephone number (e.g. 0123456789)
Mobile (e.g. 0623456261)
Fax (e.g. 0123456789)
*Fields marked with an asterisk must be completed

Hire
Please enter the number required

Adult bikes

Please indicate whether male or female:
(M for a Man) - (W for a Woman)		 Bikes for children and adolescents
Urban bike comfort Hybrid bike Touring bike Mountain bike VAE Baby bike 12" to 16" Child's bike 20" Junior bike 24"

TrailerTandemBaby seat
Child trailer Trailer for dog Crazy bike TandemTricycle Baby seat Dog basket

Scooters
50 cc100 cc

Hire date required  ( DD/MM/YY)
Holiday address  (name of town)
Number of days required  (approximate)
 

 

Please send this form, together with a cheque for the deposit (50% of the total cost) to the following address:
Cyclo Surf BP8 - 17740 - Sainte Marie de Ré to enable us to confirm your reservation.
The cheque will only be deposited upon collection of the equipment you have hired.
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I wish to receive further information from you by e-mail.

In accordance with the Loi Informatique et Libertés [the Computer and Freedoms Law] dated 6th January 1978, you have the right to access and modify any personal information.

Our company or association remains the sole recipient of any information sent for its attention.