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. Contact the E Club with any questions.

* = required field

First Name*
Last Name*
Residence Hall*
Room #*
Year in School (for 2014-15 year)
Cell #*
Your Email*
Disclaimer:
Payment Amount*
Entrepreneurship club has the ability to refuse the rental of a refrigerator.
By filling out this form you have made a request to rent a fridge. However, only a specified amount of fridges are available. It is a first come first serve basis, and you will be notified, in a timely manner, if you will be receiving a fridge. If we cannot fulfill your request, your payment will be refunded.
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