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University Police Department |
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Bicycle
Registration Form
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I. PERSONAL INFORMATION:
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| First Name: | Last Name: | Email Address: | ||||
| Mailing Address: | ||||||
| Street: | P.O. Box: | |||||
| City: | Phone: | |||||
| Zip Code: | 2nd Phone: | |||||
| Home Address (If different from Mailing Address): | ||||||
| Street: | P.O. Box: | |||||
| City: | Phone: | |||||
| Zip Code: | 2nd Phone: | |||||
| II. BICYCLE INFORMATION: |
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| Make: | Model: | Men's: | Women's: | Speeds: | ||
| Bicycle Serial Number: | Click Here for Bicycle Serial Number Locations! | |||||
| Other Identifying Marks: | ||||||
| Date Purchased: | Value When Purchased: | |||||
| (1) Fill in | ||||||
| (2) Print out | ||||||
| (3) Sign this form below. Deliver it in person with your bicycle to: | ||||||
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CSUN
Parking & Transportation Services, The Parking Office, UPA Building
14, Room 105.
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(You
must complete this process for your Registration to be complete!)
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| I CERTIFY THAT THE BICYCLE I AM REGISTERING BELONGS TO ME AND WAS OBTAINED LEGALLY.I WILL PROVIDE SUCH PROOF UPON REQUEST. I UNDERSTAND THAT REGISTERING MY BICYCLE THROUGH THE UNIVERSITY'S BICYCLE REGISTRATION PROGRAM IS NOT A GUARANTEE THAT MY BICYCLE WILL BE PROTECTED FROM THEFT OR LOSS. INSTEAD, THE PURPOSE FOR REGISTERING MY BICYCLE IS THAT THE INFORMATION I SUPPLY ON THIS FORM MAY BE USED TO CONTACT ME IN THE EVENT THE UNIVERSITY RECOVERS MY BICYCLE AFTER A THEFT OR LOSS. THIS REGISTRATION WILL REMAIN IN EFFECT THROUGH THE END OF THE NEXT ACADEMIC YEAR AND I AM RESPONSIBLE FOR PROVIDING UPDATED CONTACT INFORMATION SHOULD ANY OF THE ABOVE INFORMATION CHANGE. | ||||||
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| Signature: _______________________________________ | Date: ___________ | |||||