Policy Registration NB

Policy Registration NB

info@bikeshield.bike 1-888-988-6334
Before you start, please have ready:

-          Picture or file of purchase receipt including upgrades

-          Picture(s) of bicycle + components

-          Picture of frame number

If any upgrades or additional accessories, such as power meter, dropper post, wheels, etc, have pictures, including serial numbers, ready to upload.

The policy requiring a monthly payment is subject to a deductible during the first 3 months;

30% for the first month,

20% for the second month,

10% for the third month.
Date*

MonthDayYear
Date
The owner
E-mail address*

Confirmation Email
Phone Number*
Owner of bicycle*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Billing address

Same as aboveOther
Address

Street Address

Street Address Line 2

CityState

Zip Code
I want to use my bicycle shop

YesNo
The preferred shop
Name preferred bicycle shop*
Contact person*
Phone number preferred bike shop*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip Code

Total for the coverage
Registration fee
Value of items for coverage
Price for premium/month
Price for 2 years
Choose coverage*

Price for premium/monthPrice for 2 years
Total for 1st month +registration
Grand total for 2 year policy
After submitting, administrator will review the form for approval.

This can take up to 24 hours. If approved you will recieve an email with a link that will provide the payment details.
Should be Empty: