Part 1
Your Information

First Name:

Last Name:

UM Uniquename:

Your email address *
* required for form to work properly

UMID :
(enter as 00000000)

Today's Date :

Are you on Residence Staff: yes no
(Residence Staff who request a refrigerator will be provided with a small. You may upgrade Refrig/Micro combo for $50.00)

Part 3 Select your type of refrigerator
Refrigerator/Microwave Combo (not available in Baits I or II)
	Color: Black Fridge Capacity: 2.13 cu. ft. Freezer Capacity: 0.75 cu. ft. Total Capacity: 2.9 cu. ft. Doors: 2 Microwave: 600-700 Watts Height: 44.5 in Width: 19.5 in Depth: 19.5 in Weight: 84 lbs (Model pictured may not be the exact model you receive)
Small (2.5 Cu. Ft)
	Color: Black Freezer Section: Minimal Total Capacity: 2.5 cu. ft. Exterior Doors: 1 Height: 25 in Width: 19 in Depth: 20 in Weight: 49 lbs (Model pictured may not be the exact model you receive)
Part 4 Payment and Agreement
• University Housing will charge to your student account the rental fee. The total payment is due when invoiced by University Student Financial Operations. Late payment charges are governed by the policy of the Student Financial Operations office.
By submitting this application, I agree to pay the rental amount billed to my Student Account.
(Please press submit once and wait for a confirmation screen. It is normal for the system to take up to one minute to process your application)