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Bicycle Registration Form

2. Owner Information

4. First Name*

5. Last Name*

7. Address*

9. City*

10. State

11. Zip Code

13. Phone Number*

14. Email Address*

18. Bicycle Information

20. Make*

21. Model*

22. Color*

23. Type*

25. Speed*

26. Serial Number*

27. Approximate Value*

28. Location Purchased*

30. Select One*
    -- Select One --MaleFemale

32. Other Identifying Features

33. Upload Picture of Your Bicycle

35. Terms and Conditions
    By Checking the box below, I certify that the bicycle I am registering belongs to me and was obtained legally. I will provide such proof upon request. I understand that registering my bicycle through the Napa Police Department bicycle registration program is not a guarantee that my bicycle will be protected from theft or loss. Instead, the purpose of registering my bicycle is that the information I supply on the form may be used to contact me in the event the Police Department recovers my bicycle after a theft or loss.

    By Checking the box below, I certify that the bicycle I am registering belongs to me and was obtained legally. I will provide such proof upon request. I understand that registering my bicycle through the Napa Police Department bicycle registration program is not a guarantee that my bicycle will be protected from theft or loss. Instead, the purpose of registering my bicycle is that the information I supply on the form may be used to contact me in the event the Police Department recovers my bicycle after a theft or loss.

37. I agree to the terms listed*

    1. Yes

Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field