Organization Name: Account Number:

Contact Person: Position:

Phone: Your Email:

 

Event Title: Event Date:

DATE CARD READER IS NEEDED:

Location: ULRICH Student Center UC - University Center

Start Time When Card Reader is Needed: End Time:

What will you be selling:

How Much Per Unit: $

RENTAL FEE: $25 (3% OF ALL TRANSACTIONS WILL GO TO THE BURSAR)

Disclaimer:
I have read the "Rules & Policies of the Lehigh University Student Senate Card Reader Program" and agree to all terms and conditions in renting the Card Reader. Also myself, along with my organization, , agree to be responsible both for the return of Card Reader and any and all Financial Transactions that are incurred.
AGREE: Yes/No: