MiniFridge with Microwave Rental Order Form
Thank you for your interest in renting a MiniFridge with Microwave. If you are a CUA student, your student account will be billed for the rental. If you are a non-CUA student, you may pay for the rental by credit card. The rates are as follows:

$99.99 per semester (CUA Students)
$125 per semester (non-CUA Students)

For additional pricing, terms and conditions, please see the Rental Agreement (https://goo.gl/41CWmB).

Email address *
Full Name *
Your answer
Student ID Number *
Your answer
Building
Your answer
Room Number
Your answer
Phone Number *
Your answer
Term(s) *
Required
Do you accept the terms and conditions of the CUA MiniFridge with Microwave Rental Agreement (https://goo.gl/41CWmB)? *
Required
A copy of your responses will be emailed to the address you provided.
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