PART I.  (ORIGINAL INFORMATION ONLY):

Name:        (Required)   

No Changes

Cell Phone: (Required)

College:    (Required)

Dorm and Room:

Mailbox Number:

Home Phone:

School Email:

Home Email:

Please check the box that applies to your situation:

Please provide the new information below:

* Required Field

Name: *

College: *

Dorm: *

Room: *

 Mailbox Number:

School Phone Number: (if none, please use cell phone blank below)

Home Address: *

Home City: *

Home State: *

Home Zip: *

Home Phone: *

Cell Phone: *

School Email:*

Home Email:

Parents Email:

Please Check the box below:

I agree to take responsibility for the refrigerator rented by the person named above and will return it as specified in the original contract.

ALL FINANCIAL ARRANGEMENTS THAT RESULT BECAUSE OF THIS SWITCH ARE TO BE SETTLED BY THE ORIGINAL LESSEE AND THE NEW LESSEE.