Handcycle Order Form

please either print this out and mail it to the address below or email us the information.
Name:
Address:
City:
State/Country:
ZIP:
Email address:
Home Phone:
Work Phone:
Mobile Phone:

One-Off Titanium Inc.

221 Pine St.
Florence, MA 01062
Phone & Fax (413) 585-5913
Web: www.titaniumarts.com
Email: mike@titaniumarts.com


The five things we need to know in making your bike right for you are:

1. Your Body Dimensions


 Height:

Weight:

Seat Width:

Upper Leg Length:

Lower Leg Length:

 

2. Tire and Wheel Choice
See the spec sheet for a description of our various wheel choices. It seems that almost everyone wants the big fat back tire and the usual BMX sized fronts. The following questions will help us get the right tires for you.

I plan to use my handcycle for the following:

All the Time! ..........................Never!
    1          2          3          4          5   Downhill Racing, Chair Lift
    1          2          3          4          5   Peak Bagging, Hill Climbing, Extreme Adventure
    1          2          3          4          5   Wilderness Access, Camping
    1          2          3          4          5   Mountain Bike Racing
    1          2          3          4          5   Dirt Roads, Trail Riding
    1          2          3          4          5   Road Racing
    1          2          3          4          5   Street Riding, Traffic
    1          2          3          4          5   Utilitarian, Commuting
    1          2          3          4          5   Bike Path
Other:________________________________

3. Personal Description
Please describe your level of disability:

Please describe your experiences with other handcycles. i.e. parts broken, crashes, amount used, places used, choice of tires.

What other sports do you enjoy?

 

4. Color Preference:


5. How did you hear about our handcycle?

 
© One-Off Titanium, 1/8/2002