Bicycle Request Application

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

Student Information

Class Year:
Freshman Sophomore Junior Senior
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.