UKMotorbikeHire.co.uk, York

Name

E-mail address

Date of birth

Address

Postcode

Phone No

Nationality

Driving licence No.

Date of issue

Place of issue

Number of years FULL MOTORCYCLE licence held (must be more than 2 for 250cc bikes. Ring if less)

Select your bike

Please select your first and second choice of motorbike from the list below

1st Bike*

Hire bike from

Hire bike until

Bike pick up time

Passport number (if non UK citizen)

Address during stay in the UK

Have you been convicted of any motoring offence during the past five years or had your licence suspended during the last ten years or is any prosecution pending?

NoYes

If yes please provide details

Have you ever had a proposal declined, a policy cancelled or renewal refused or been required to pay an increased premium or had special conditions imposed by a motor insurer?

NoYes

Have you any physical or mental defect or infirmity or have suffered from diabetes fits or any heart complaint?

NoYes

Have you had any accidents and/or claims in the past 36 calendar months?

NoYes

If yes please provide the details below

I have read and accept the terms and conditions and agree that they shall apply to the contract between myself and Yorksbike limited.

I particularly acknowledge that should I fail to provide the documentation as specified at the point of collection, hire will be refused and no refund will be given.

Submit

*Required