Welcome to the Siena College Summer Order Form

This page is for LEASING only, if you would like to buy a MicroFridge,

Refrigerator, or Safe, please return to the Home Page and choose the BUY link.

PLEASE PRESS CAPS LOCK KEY NOW.

By submitting this form, you are agreeing to these Terms and Conditions

Please begin at Question 9.  Use your mouse or the TAB key to navigate through the form. 

DO NOT PRESS ENTER UNTIL YOU HAVE COMPLETED ALL FIELDS AND ARE READY TO SUBMIT THE FORM.  If you press enter by mistake, use the "back" button, and continue from last completed field

1.  FIRST DELIVERY DATE:

2.  SCHOOL:


3.  COUNTY:


4.  SCHOOL CITY:


5.  SCHOOL STATE:


6.  SCHOOL ZIP:


7.  ORDER METHOD:


8.  TYPE:


9.  TODAY'S DATE: PLEASE ENSURE YOU HAVE PRESSED THE CAPS LOCK KEY BEFORE CONTINUING.

mm-dd-yy (you must use dashes for date to be entered properly)

10.  ON CAMPUS RENTAL:


If you do not have the information for questions 11-14, don't worry.  You can email it to us as soon as you have it!   Email address: refrigeratorleasingcompany@yahoo.com

11.  HALL:


12.  ROOM:


13.  STUDENT CELL PHONE:


14.  STUDENT EMAIL ADDRESS:


15.  STUDENT'S FIRST NAME:


16.  STUDENT'S LAST NAME:


17.  YOUR FIRST NAME:


18.  RELATIONSHIP TO STUDENT:


19.  HOME ADDRESS:


20.  HOME CITY:


21.  HOME STATE


22. HOME ZIP:

23.  PARENT CELL PHONE:


24.  PARENT EMAIL ADDRESS:


25.  CLASS:


26.  FRIDGE TYPE:


27.  FRIDGE PRICE:

             PLEASE SELECT THE PROPER PRICE FOR YOUR TERM:

                4 WEEK RENTAL: $50.00 + $10.00 Refundable Security Deposit

                6 WEEK RENTAL: $60.00 + $10.00 Refundable Security Deposit

                8 WEEK RENTAL: $70.00 + $10.00 Refundable Security Deposit

                FULL SUMMER RENTAL: $80.00 + $10.00 Refundable Security Deposit

 

28.  TOTAL PRICE:  In this blank (item 28), insert the same price you selected above for item 27.

               Entering the total price into the box means you have read and understood the Terms and Conditions

                                    and you authorize this amount to be charged on your credit card.

29.  CREDIT CARD NUMBER WITH SPACES:

            Visa/Mastercard only

Example: 7777 7777 7777 7777 (You must use spaces between the numbers for credit card to be read properly.  If you do not use spaces, the order will not submit and you will be asked to properly enter the credit card.)

30.  EXPIRATION DATE :

Example: 0413 Please use the proper number for the month, not abbreviations. Please do not separate the month and year with any punctuation or spaces.

31.V-CODE:   (The V-Code is the last 3 digits found on the back of the credit card following the account number)

 

32.  STUDENT ARRIVAL DATE:

mm-dd-yy (you must use dashes for date to be entered properly)

33.  NON-FRESHMAN:  Did you rent a MicroFridge from us last year?

Please print the Form Confirmation page that appears after you submit the form.  It will be your only copy of this form. If you need to contact us for any reason, please email us at refrigeratorleasingcompany@yahoo.com

 


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