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* 1. Contact Name

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* 2. Business Owner Name (if different from above)

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* 3. Business Address

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* 4. Primary Phone Number

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* 5. Email Address

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* 6. How many employees do you have?

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* 7. How many full time equivalent positions?

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* 8. How many years as the business been in operation?

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* 9. Type of business? (Select one)

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* 10. Do you offer secure, dedicated bike parking for guests/customers? (Select one)

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* 11. Describe the dedicated bike parking. (Check all that apply)

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* 12. Approximately how many bicycles can be accommodated by the dedicated bike parking? (Select one)

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* 13. Does the majority (more than 50%) of the bike parking meet the following standards for quality, security, and convenience? (Check all that apply)

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