Bicycle Parking Request

Managed by the Department of Personnel & Administration
Division of Central Services/Capitol Complex

Application Date  

 

Name of Applicant                  

Employer             

Applicant Work Address   

City                     State:    ZIP

Work Phone       FAX:    

Work E-mail   
 

Brand/Type/Color/Registration (if available) of Bicycle

How many times per week will you use the locker?