Rennselaer Polytechnic Institute

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Student Information

First Name:

Initial:

Last Name:

Student ID:

Hall:

Room:

Phone:

Email :

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Billing Information (must match billing address of credit card or bank account)

First Name:

Last Name:

Country:

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City:

State / Province:

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Payment Information

Pay with: Credit Card Checking Account Savings Account

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Expiration:

CVV:

I authorize Collegiate Concepts, Inc. to debit the financial account indicated in this web form, for the noted amount on today's date. I understand that because this is an electronic transaction, these funds may be applied against my account as soon as the above noted transaction date. I will not dispute Collegiate Concepts, Inc. debiting my financial account, so long as the transaction corresponds to the terms indicated in this web form.

I have read the terms and conditions in the rental agreement.

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What does "All-Inclusive Insurance" cover?

The "All-Inclusive Insurance" offered by Collegiate Concepts, Inc. covers All Damage to the rental during the rental period. This includes all parts of the rental. The insurance would NOT include the loss or Theft of the rental.

The "All-inclusive Insurance" is OPTIONAL

You are NOT REQUIRED to purchase it. To remove it from your order, simply change the Quantity field next to it to 0 and click the "UPDATE QTY" button to have it removed. Even though the insurance option is optional, over 65% of the customers choose this option historically. It has saved thousands of dollars for customers. We highly suggest you choose this option.

What does "Clean Option" include?

The "Clean Option" offered by CollegeFridge.com (Collegiate Concepts, Inc.) allows you to focus on other items at the end of your rental term. We will clean your fridge for you, all you have to do is remove all personal items, and the rest is up to us! No mess, no fuss, no cleaning charges when we pick it up.

The "Clean Option" is OPTIONAL

You are NOT REQUIRED to purchase it. To remove it from your order, simply change the Quantity field next to it to 0 and click the "UPDATE QTY" button to have it removed.

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All cleaning and installation guidelines established by the state, OSHA, the CDC and any other regulatory agency will be followed at all times.

If you did not have your residence hall and/or room number assignment at the time of your order, please be sure to notify us via phone, email or fill out a service request as soon as your information has been obtained so we can update your record. Thank you!

Product	Quantity	Price Each	Total

Billing Information	Student Information