Bicycle Registration

Please take the time to fill out as much information as you can below.  You can also print this form out using file print on your browsers tool bar.  You could then mail it to the police department or drop it off when you are in the area.  Further down the page, we will ask you to create a code word.  Use up to twelve characters in any combination.  When you are complete with the form a confirmation page will pop up showing you all the information you sent.  Print this page out using the above procedure and store it in a safe place.  You can use this to identify your bike, should we find it if it ever becomes lost or stolen.

Personal Information:

*Full Name:  
 
*D.O.B.(MM/DD/YYYY):  
 

Address Information:

 
*Ventnor Address:  
 
*Permanant Address:  
 
*City:  
 
*State:  
 
*Zip Code:  
 
*Phone:    
 
*Email:  
 

Your Bicycle Description:

 
*Make:  
 
*Model:  
 
*Serial Number(Mandatory):  
 
*Type of Bicycle:
 
*Frame Style:
 
*Frame Size:
 
*Number of Gears:
 
*Frame Color:  
 
*Value:  
 
*Accessories:


 
*Create a code word. Please create a code word, up to twelve characters long. It can be used to verify the registration of your bike with the police department.  
 
*Additional Bicycle Description and/or Comments: