BuyCycles Referral Application
Application for the BuyCycles Project
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Email *
Application Terms Of Agreement
The applicant agrees to the following:
  • Agree to enter into this contract to purchase through BuyCycles.
  • Take care of any bike purchased and is responsible for the security of the bike at all times.
  • Will not on-sell the bike in terms of this agreement.
  • This agreement does not include any insurance for damage or theft.
  • If the bike is stolen, payments will continue to the value, unless an agreement is made.
  • If for any reason you no longer require the bike, before payment is made in full, you are able to return the bike, and understand that you may not receive a full refund due to depreciation.
  • If for any reason, injury takes place, BuyCycles will not be liable. 
  • Agree to share your experience of the BuyCycles project if required.
  • Cost includes an admin fee
  • Locks & Helmets will be available for purchase as part of the package for $25,00 each. There maybe some free helmets in stock at times.
  • Payment either set up prior to receiving goods or confirmation from WINZ.
Referral Organisation *
Clients Name *
Contact Number/email *
Address *
Support Worker Details - Name / Contact email / Cell *
Next Of Kin Details - Name / Contact email / Cell *
Age Group *
Required
Ethnic Group *
Required
Type Of Bike Required - Style / Size / Maximum Spend *
WINZ Payment Application *
Agree to regular payments, set both start and end dates, and will pay any overdue payments. *
Required
A copy of your responses will be emailed to the address you provided.
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