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NAME______________________________________________________________________

STUDENT ID #____________________

PERMANENT ADDRESS _____________________________________________________

__________________________________________________________________________

CAMPUS/DAYTIME PHONE __________________________

PERMANENT/HOME PHONE__________________________

DEPOSIT AMOUNT: $25     $50     $100     $200     Other______________

METHOD OF PAYMENT: Cash     Check     Visa     MasterCard     Discover

SIGNATURE ________________________________________ DATE _____________

CREDIT CARD # ________________________________ EXP. DATE _____________

 

Deposits may be mailed to: WVU Cashier's Office, P.O. Box 6430, Morgantown, WV 26506-6430. Make check payable to West Virginia University. To add funds call Office of Student Accounts (304-293-4006) or Student Affairs Cashier's Office (304-293-3621).. Deposits to accounts indicate that you accept all regulations/conditions that apply to this account. For answers to Mountaineer Card questions call 293-CARD.