FaceBook MicroFridge Order Form

TODAY'S DATE: example: 06-22-08

FIRST DELIVERY DATE:

 Unit will be shipped a few days after ordering, or we can hold shipping until the student reaches college. 

SCHOOL:

Please type in the college the student will be attending

HALL:

ROOM:

STUDENT FIRST NAME:

STUDENT LAST NAME:

CLASS:

FRESHMAN SOPHOMORE JUNIOR SENIOR GRAD STUDENT OTHER

TYPE OF REFRIGERATOR:

NEW MICROFRIDGE 2 DOOR

PLEASE SELECT BELOW NEW MICROFRIDGE 2 DOOR

 

PRICE:

NEW MICROFRIDGE 2 DOOR - $469.00

PLEASE SELECT THE PROPER PRICE: PLEASE SELECT BELOW 469.00

Price includes shipping to your home or school!

TOTAL PRICE:

$ Please type the correct price listed above. By entering the total price into this space, you give permission to charge this amount to your Visa/Mastercard.

CREDIT CARD NUMBER WITH SPACES:

            Visa/Mastercard only

Example: 0000 0000 0000 0000 (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.)

EXPIRATION DATE and V-CODE*:

(* THE V-CODE IS THE 3 DIGIT NUMBER FOUND ON THE BACK OF THE CREDIT CARD ON THE SIGN STRIP. IF THERE ARE MORE THAN 3 DIGITS ON THE SIGN STRIP, PLEASE USE THE LAST 3).

Please call 607-431-9525 if you have any questions about the V-Code:

Example 04-04 468 Please enter V-Code 1 space after expiration date.

CARDHOLDER NAME:

HOME ADDRESS:

HOME CITY:

HOME STATE

HOME ZIP:

HOME PHONE:

STUDENT CELL PHONE:

PRIMARY EMAIL ADDRESS:

NOTES:

Please keep notes less than 50 characters.