Name:

Address:

City:

State:

Zip:

Phone:

Email:

Age:
Please tell us your age 21-30 31-40 41-50 51-60 60+ *

Do you have a drivers license?
Yes No

How far are you willing to walk to pick up an I-GO vehicle?
Select a distance 2 blocks 4 blocks 6 blocks 8 blocks

How often do you believe you would use an I-GO car?
Select how often Once a month Once a week 2-3 times a week daily

How did you hear about I-GO?
Please select one Internet Friend Flyer Newspaper TV Mailing Neighborhood Group Work Saw Car Saw Banner Other

*You must be 21 years or older to participate.

Telling us where you live helps us serve you better. We need to know where you are so we can bring I-GO to you. This information will not be shared with any other party.