Register Your Bike!

REGISTER YOUR BIKE!
Register your bike on-line.
It’s fast! Convenient! Super Easy!
Receive a small, aluminum Security ID tag.
Once placed on your bike it’s almost impossible to remove!**

West Palm Beach Police Department
Internet Report Form

Please fill in the form below completely. Then Click the “Submit” button at the bottom of this page. Required fields are denoted with an asterisk “*”. If a required field does not pertain to you, please type “n/a” in that area.
Bicycle Registration Form
Name:
Street Address:
Apt or Unit No:
City:
State:
Zip Code:
Home Telephone:
Date of Birth:
Bicycle Make: New: Used:
Bicycle Model:
Serial Number:
Owner Engraved Name:
Frame Color :
Fenders Color :
Trim Color :
Frame Size:
Frame Style: Girls’ Boys’
How many speeds?
Please select the items installed on your bike.
Front Fender
Rear Fender
Front Light
Rear Light
Front Basket
Rear Basket
Would you like a security ID tag?
Email Address:
Other remarks, comments, or questions:


Please enter the text above into this box:

**Suggested Donation: $1.00
Your donation will help fund this program.
Please send $1.00 cash or check to:
Crime Prevention of West Palm Beach, Inc.
600 Banyan Blvd
West Palm Beach, Fl. 33401

Thanks!

Please note: Information collected through this form is intended for use by the West Palm Beach Police Department and not for distribution to third parties.