Charger Cycle Request Form - Spring 2020
Please fill out the below information to submit your request for a Charger Cycle for the Spring 2020 semester.

**This form is a REQUEST FORM ONLY. You will be informed via email whether or not you will be receiving a bike by January 4, 2020. We have a limited number of bikes that will be given out in the order that we received the request. If you are not one of those that will be receiving a bike at first, you will go on a wait list and will be contacted as soon as a bike is available.
Name: *
Your answer
A#: *
Your answer
UAH Email: *
Your answer
Phone Number: *
Your answer
Place of residence: *
Status: *
Type of Charger Cycle you would like: *
Have you rented a Charger Cycle before? *
Do you have any other modes of transportation on campus? *
I understand that I am responsible for the Charger Cycle that is assigned to me for the semester. *
I understand that I will be charged a fee of $450 to my UAH student account if the Charger Cycle, lock and key are misplaced/lost or are not returned by the last day of finals, April 28, 2020. *
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