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