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2. 
4. *Submitting this form does not register your bike.*

   This form is a pre-registration form to schedule an appointment with an officer for inspection. 

6. Date*
   Date
7. E-bike Register*

   1. Parent/Guardian
   2. Owner
8. Full Name*
10. Primary Rider*

    Full Name

12. Address*
14. Subdivision*
15. Residency*

    1. Resident
    2. Non-resident
17. City*
18. State*
19. Zip Code*
21. Home Number*
22. Cell Number*
24. Email Address*
26. Make*
27. Model*
29. Color*
30. Serial Number*

32. For questions or more information, contact Officer Hubbard at ehubbard@prospertx.gov

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field