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01327 857213 info@wheelstowork.net

Application form

Step 1

Step 1

Step 2

Step 2

  • Step 1
  • Step 2

Section 1

In order to join the Wheels to Work Silverstone scheme, you must be based in either Northamptonshire, Oxfordshire, Berkshire, Buckinghamshire, Leicestershire, Bedfordshire or Warwickshire. We also have a minimum hire term of four months, if you would like a bike for a short term hire or are outside of the counties listed above, you won't be able to join the Wheels to Work scheme but you may still able to hire, please email us to find out more.

First Name

Surname

Date of Birth

Address

Town

Post Code

Mobile Number

Email Address

Please tell us why you would like to hire a scooter/125 motorcycle from us?

What type of licence do you have?

If you have a licence (provisional or full) what date did you get it?

Do you have a valid CBT?

Do you have a scooter preference: 50cc or 125cc?

How long would you like a bike for? We have a minimum term of four months.

Where will you keep the bike during the day?

Where will you keep the bike at night?

Are you currently employed or at college? If yes, please let us know your job is or what you are studying.

Section 2

Have you been involved in a motor accident in the past 3 years?

If you answered yes to the above question please provide some more information on what happened.

Have you made a claim against a motor insurer in the past three years?

If you answered yes to the above question please provide some more information on what happened.

Have you been convicted of a motor offence in the past five years?

If you answered yes to the above question please provide some more information on what happened.

Have you been disqualified from driving in the past eleven years?

If you answered yes to the above question please provide some more information on what happened.

Have you ever been convicted of a criminal offence?

If you answered yes to the above question please provide some more information on what happened.

Have you ever suffered from any physical or mental infirmity, diabetes, fits or heart complaint?

Have you ever been refused motor insurance, quoted an increased premium or had special terms imposed?

Have you always lived in the UK?

If you answered no to the above question please provide some more information.