JMU CARD SERVICES ON-CAMPUS APPLICATION

Send application to:

Card Services, 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

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

Declining Balance Accounts:

Please indicate deposit amount

  FLEX                                       

    Dining Dollars Gold

METHOD OF PAYMENT:

 Personal check [make payable to James Madison University]          

VISA  MasterCard  Discover  Other

CREDIT CARD NUMBER:   
Expiration Date:  

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

Signature of Credit Card Holder