Campus Safety

Automobile Registration

Employee/Student Number:
First Name:		MI:
Last Name:
Drivers License#:
Vehicle Owner's Status:
Student Status:

Permanent Home Address

Address:

City:

State:

Zip:

Home Phone:

Campus or Local Address:

Residence Hall:

Room #:

Phone #:

JBU Box#:

Auto License Plate#:	State:
Auto Color:
Make:		Model:
Year:
Body Style:

Registered Owner of Vehicle:
Address of Registered Owner:
City:		State:
Zip:

By submitting this form, you agree to the following:

I have read and understood the JBU Parking and Traffic Regulations,
and I agree that after my unpaid fines become past due, my vehicle(s)
may be immobilized until all fines are paid. Payment of parking tickets
may be made by cash, check, or placed on student account.

Students Only:
I am aware that there is a one-time annual fee to register each vehicle.
This fee will be placed on my student account. Yes (required)

Please allow 6 business hours for your application to be processed. Once your application has been processed, you can pick it up at the Campus Safety Office in the Central Plant by appointment.
Please affix this decal to the lower front passenger side of your windshield.