UBC BOOKSTORE COURSE MATERIALS RENTAL AGREEMENT

(please note, if you are under 19, you will need your guardian or parent to sign this form)

Student ID#_____________________

I, First Name:_____________________ Last Name:_____________________

agree to the following terms and conditions:

Credit Card #________________________________________

Expiry:__________________________

(mm/yy)

Cardholder’s Name:________________________________

(as it appears on your credit card)

Credit Card Billing Address:_____________________________________________________________

City:______________________________ Province:________ Postal Code:_______________________

Phone:_________________________________ Email:______________________________           

To be filled out by Cashier:

Verified credit card number and expiry date ________________(initial) Cashier ID#__________________

Student UBC Card#_________________________________________(verified/initial)

Due Date (for Spring/Summer 2012 term):20 August, 2012________________

ISBN(s) #:______________________________________________________________________

Rental Fee: __________________________________________________________

Terms and Conditions: