Bicycle Request Application

Application must be submitted by 5 p.m. on Friday, August 22nd

Student Information
Class Year:
Cell Phone:
Campus Address:
Home Address:
Zip Code:
Personal Medical Insurance:
Bicycle Rental Information

Has D.Cycle ever previously provided or serviced a bicycle for you?

I am currently renting a D.Cycle bike
I have rented a D.Cycle bike before
My personal bike has been serviced by D.Cycle
I have never used D.Cycle's services

If you have previously had a bicycle serviced or provided by D.Cycle, please list the time of service provided and details:
D.Cycle has limited student bicycles. Please provide details as to your transportation needs.