Property Registration

STUDENT ID #:

FIRST NAME:

LAST NAME:

Email Address:

CELL PHONE NUMBER:

HOME PHONE NUMBER:

LOCAL ADDRESS:

CITY:

STATE:

ZIP CODE:

PERMANENT ADDRESS:

CITY:

STATE:

ZIP CODE:

ITEM: DESKTOP LAPTOP GAMING UNIT BIKE CAR STEREO OTHER

IF OTHER PLEASE SPECIFY:

VALUE:

MAKE:

MODEL:

SERIAL #:

COLOR:

OTHER IDENTIFYING INFORMATION

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