JMU CARD SERVICES FLEX AND DINING APPLICATION
Send application to:
Card Services, 738 South Mason Street, 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: CID Number:
Billing Address (this is required for your application to be processed)
Signature of Credit Card Holder
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