(circle one)

Single Bed Loft System -- $175
Double bed Loft System -- $350

(per academic year)
 

Permanent Address: __________________________________________________________

City: ____________________________  State: _____________________________ Zip: ______________________            

              (circle one)          Morgan          Thomas          Bradford          Randall        Weaver Towers

Room Number , if known:________________________ 

Roommate's Name, when available (for double loft only) _____________________________________________

Credit Card # _____________________   Expiration Date: _____________

Name appearing on Card: ________________________________________   Last 3 or 4 digits on back of the credit card______________

visa        mastercard     discover   (circle one)

*Refund policy:  There are no refunds on beds that have already been set-up in the designated rooms. If not attending school a 90% refund will be made if nodified before move-in day.