Mobile Pedestrian and Bicycle Counter Equipment Request Form

Contact Information

Please provide us with the following contact information, so that we may contact you if we have any questions.

All fields are required.

Required Required Required The email address entered is not valid. Required

Organization Information

Please provide us with the following organization information.

All fields are required.

Required Required
Required
Required
Required

Counter Request Location

You must either upload a file or indicate that you need to discuss the proposed counter location(s).

Counter Request Location

Please provide us with the following information for your request.

Unless otherwise noted, all fields are required.

Required Required
Required

Please select your preferred two-week period for the requested counts.

If you need more than two weeks, please explain why in the “Additional Notes” section.

Required Required Required Required
Required
Required

Review Your Contact Information

Name

Email Address

Phone Number

Review Provided Organization Information

Organization

Type of Organization

County

Review Your Counter Request Details

Location Upload

Number of Counters Needed

Type of Count

Begin Collecting Counts

Stop Collecting Counts

Count Purpose

Count Previously Collected

Additional Information on Previous Count

Additional Notes