Friendship Family Bicycle Loan Program Application printable pdf download

Minnesota State University, Mankato

Friendship Family Bicycle Loan Program

Student Information

Print Name:___________________________________________________ Tech.ID _______________________

Address: ___________________________________________________________________________________

Phone: __________________ E-mail:_____________________________________________________________

Date Loaned:__________________ Deposit Amount: $50_____

Bike Serial # _____________________

Date Returned: _________ Refund Approved: ______________Amount Returned to Student’s Account: ________

Comments: __________________________________________________________________________________

Rental Agreement

I understand that the mission of the FFP Bike Sharing Program is to assist new international students who

might be in need of this service.

I understand that I am responsible for the bicycle borrowed under this privilege.

I understand that there will be a $5.00 depreciation and maintenance fee per month taken off the $50.00

deposit.

I understand that no direct cash will be returned to the student.

The Friendship Family Program is not responsible for any injuries caused by this bicycle while under my

personal usage and I am expected to obey the safety city bike laws

(

Safety/Page.aspx)

The maximum bike loan period is 9 months (March – November).

It is my responsibility to return the bicycle in good condition to the Friendship Family Program

(Mariam Qureshi) when I no longer need the bike and before November.

I understand that I cannot pass on the bicycle to other students without the FFP Coordinator’s (Mariam

Qureshi- 507-389-6592,

icservices@mnsu.edu

) approval.

I understand that the university will put a hold on my account for a bicycle that is not returned.

I understand that 1

, 2

and 3

year students are given priority in this bicycle loan program.

Signature: __________________________________________________ Date _____________________

Note

The Friendship Family Program and Kearney International Center personnel must send a signed copy of this form to the Student Financial Services office,

Account Clerk at WA 120-507-389-1352 when the bike is returned and a refund is determined to be appropriate. The refund is to be deposited into the

student’s MSU account. If the student’s account has a balance due, the credit will be applied. A check will be sent to the student’s permanent address or

direct deposit to a bank account will be made if the student has it set up through Business Services. No direct cash will be given back to the student.

Please allow 2-3 weeks for processing the refund.

Student Financial Services Office- Account Clerk

Returned: _____________________________________________ Date: ______________________________

Refunded: _____________________________________________ Date: ______________________________