6/26/2014 11:32:02 AM::Viterbo Emergency Test #3. No action required.

6/26/2014 11:30:15 AM::Viterbo test message #2. No action required.

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Locker Rental


First Name                         Last Name

    
Street Address

City                                     State           Zip Code
            
Telephone                      Email
      

Classification:                 
                        
                     
                     

Locker Info:

Men's       
Locker #  
Lock Serial # 

Rental Terms:

Summer 2014 (May 16 - Aug 15) $5.00

 2014 (Aug 16 - Jan 15) $10.00
(Jan 16 - May 15) $10.00
Summer 2015 (May 16 - Aug 15) $5.00
Payment Type:
 
  Check #

Amount Received

User Agreement


  signed and dated?

 

Rec Sports Staff Completing Form:

Almost complete! Select Submit, and then follow the directions on the response page!