REFRIGERATOR LEASING COMPANY ORDER FORM
FIRST NAME_____________________ LAST NAME______________________
COLLEGE________________________ QUADRANGLE (Albany only)_______________
RESIDENCE HALL___________________ ROOM__________________________
SCHOOL PHONE_____________________ MAIL BOX # ________________
HOME STREET______________________
____________________________________
HOME PHONE_______________________
HOME CITY__________________________
HOME STATE____________
HOME ZIP___________
CLASS: (circle one) FRESHMAN SOPHOMORE JUNIOR SENIOR
E-MAIL ADDRESS________________________________________
STUDENT CELL PHONE: __________________________________
FRIDGE TYPE: Please call our office to see what is available at your school
(circle one:) MICROFRIDGE $200.00 COUNTER HIGH $85.00 CUBE MODEL $60.00 FRIDGE FREEZER $154.60* (limited availability) SAFE RENTAL: $99.99 SAFE PURCHASE: $189.99
PRICE: ____________________
PAYMENT INFORMATION:
1. IF PAYING BY CHECK: Make checks payable to "Refrigerator Leasing Company". Mail to 10 Railroad Ave, Oneonta, NY 13820.
2. IF PAYING BY VISA/MASTERCARD:
CREDIT CARD NUMBER: ____________________________________
EXPIRATION DATE: _________________________________________
CARDHOLDER SIGNATURE___________________________________
CALL 607-431-9525 TO ORDER OVER THE TELEPHONE WITH VISA/MASTERCARD.