JMU CARD SERVICES OFF-CAMPUS APPLICATION

Send application to:

Card Services, 170 Bluestone Dr., MSC 3532, Harrisonburg, VA 22807

Or Fax completed form to (540) 568-1749

Student ID Number

Last Name First Name M.I.

For Office Use Only

________________________________________

Location Date Student Acct Code

I agree to the terms and conditions as stated on the web page. I understand that any changes in meal plan must be made  September 3, 2012 through September 21, 2012, and that any credit that may be due will be placed in a non-refundable Dining Dollars account which must be used by May 4, 2013. There will be a $10 service charge on meal plan changes.

Signature/Relationship - If other than student (signature required)

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Declining Balance Accounts:

Please indicate deposit amount

FLEX

Dining Dollars Gold

Flex and Dining Dollars Gold cannot be billed with tuition.

METHOD OF PAYMENT:

Personal check [make payable to James Madison University]

VISA MasterCard Discover Other

Bill with Tuition [Meal Plan Only]

OFF CAMPUS MEAL PLAN OPTIONS

Meal Plan Code

Meal Plan Amt

Billing Address (this is required for your application to be processed)

CREDIT CARD NUMBER:  
Expiration Date:  
CID Number 

Total Amount Enclosed

Signature of Credit Card Holder

Meal Plan can be billed with tuition