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Rent a Refrigerator

Note: Please fill out the following form if you would like to rent a mini refrigerator from the E Club. Please review the General Terms and Agreement, the link for which is located on the left side of this page. Contact the E Club with any questions.

* = required field

Name:*
Luther e-mail address:*
Cell phone number:
Residence Hall and Room Number:
SPO#:*
Year:*
I Agree to the General Terms and Agreement (electronic signature):*
Payment Amount:*
Payment Method
Credit Card Type:*
Credit Card Number:*
Expiration Month:*
Expiration Year:*
Name as it appears on card:*
Billing Street Address:*
Billing City:*
Billing State/Province:*
Billing Zip/Postal Code:*
Billing Country: