| Bicycle Theft Prevention |
| Owner Information |
| First Name: |
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| Last Name: |
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| Student Eamil Adress (student@mail.fresnostate.edu): |
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| Alternate Email Address: |
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| Student ID Number (XXXXXXXXX): |
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| Address Line 1: |
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| Address Line 2: |
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| City:
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State:
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| Zip:
-
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Country:
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| Permanent Address (If different form above Address) |
| Address Line 1: |
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| Address Line 2: |
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| City:
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State:
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| Zip:
-
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Country:
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| Cell Phone(with area code)(XXX-XXX-XXXX): |
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| Work Phone(with area code)(XXX-XXX-XXXX): |
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| Bicycle Information |
| Bicycle Manufacturer: |
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| Bicycle Model: |
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| Bicycle Serial Number: |
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| Bicycle Value: |
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| Bicycle Color: |
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| Number of speeds on Bicycle: |
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| Bicycle Frame Size: |
ftin |
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| Bicycle Wheel Size: |
ftin |
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| Bicycle Style (choose one): |
Male
Female |
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| Identifying Marks on Bicycle: |
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I certify that I am the legal owner of the bicycle registered and will provide such proof upon request. I understand that registering my bicycle though the California State University, Fresno Police Department is NOT a guarantee of protection against theft, damage or loss.
My bicycle license and registration information will remain confidential and may only be used in the event to recover my bicycle if stolen or lost. The registration will remain in effect through the license expiration date and I agree to be responsible for notification of any information change to the California State University, Fresno Police Department.
Digital Signature Required to process this form:
Please Initial Here
Date //
(ie XX/XX/XXXX) |
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If you are having technical difficulties with the completion of form please email your request to Michele Davis |
