Send in this form to the address below when you move. OR when you sell your bicycle, to transfer your registration to the new owner.

Check one of the following:

 *

Send in this form to the address below when you move. OR when you sell your bicycle, to transfer your registration to the new owner. Check one of the following:

Transfer of Ownership

Change of Address

Description of Bicycle for Transfer of ownership / Change of address:

 *

Description of Bicycle for Transfer of ownership / Change of address:

Manufacturer	Model	Decal Number
Serial Number	Transfer Date

Seller’s information or Current Owner’s old address:

 *

Seller’s information or Current Owner’s old address:

Seller's / Owner's Name:	Old Address:
City:	State:(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:	Email Address:
Home Phone:ext.	Work Phone:ext.

New owner’s information or Current Owner’s new address: 
(Please supply new owner info even if they are a charity or if they live outside of Fort Lauderdale, or write “Unknown.”) 

 *

New owner’s information or Current Owner’s new address: (Please supply new owner info even if they are a charity or if they live outside of Fort Lauderdale, or write “Unknown.”)

Buyer's Name:	New Address:
City:	State:(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:	Email Address:
Home Phone:ext.	Work Phone:ext.

For Transfer of Ownership: Seller’s verification of sale (this signature is required to transfer registration to new owner): I, the recorded Owner, assign the above described bicycle to the Buyer named above: 

 *

For Transfer of Ownership: Seller’s verification of sale (this signature is required to transfer registration to new owner): I, the recorded Owner, assign the above described bicycle to the Buyer named above:

Signed

Date

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

100%