Form must be filled out completely to be eligible for entry.
A. Will you have the use of or access to (regardless of ownership) any vehicle during the next year?
No (If no, go to Certification section at bottom of page)
Year Make Model Color
State of Registration:
License Plate Number:
Name on the Title:
Information Regarding Purchase:
Date of purchase
B. Did someone other than a family member assist in the purchase or financing this vehicle?
If yes, please identify the individual and their relationship to you:
Was any University of Houston coach, staff member or booster involved in the purchase? Yes
If yes, please:
(1) Identify that individual:
(2) Describe their involvement:
Is your vehicle insured? Yes
It is illegal to operate an automobile in the state of Texas without insurance - This process cannot be completed without this information.
C. Is someone other than you paying the insurance premiums?
If no, list the fund source utilized for insurance premiums
If yes, Identify the individual paying the insurance premiums
Describe relationship of individual to you
By entering my name below I certify the information I have provided is accurate to the best of my knowledge, and I agree to update the Office of Athletics Compliance should any of this information I have submitted change.