Bicycle Request Application

Application must be submitted by 5 p.m. on Monday, January 27
 

Student Information

 
 
Name:
Class Year:
Freshman Sophomore Junior Senior
 
E-mail:
Cell Phone:
Campus Address:
Home Address:
City:
State:
Zip Code:
Personal Medical Insurance:
Height:

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.