PLEASE NOTE: THIS FORM IS NOT AN ONLINE REGISTRATION. IT MUST BE PRINTED AND MAILED OR FAXED.

OFF CAMPUS MEAL PLAN
REGISTRATION FORM

Name:_____________________________________________________

University ID:    _   _     __  __  __  __    __  __  __  __ 
                           (use your 10 digit university id number)

Local Address:_____________________________________________

City:__________________________ State:_______ Zip:______________

Home Phone:________________________

Select Meal Plan (one only, please):

Off-Campus Gold (minimum of $340 Deposit)

Off-Campus Plus (minimum of $25 Deposit)

Deposit: $ _________.00

Type of Payment (Check One):

__MasterCard	__Money Order
__Visa	__Personal Check
__Discover	__Cash
__American Express

If paying by credit card, please include:

Card Number:____________________________ Exp. Date:_________

Print Name on Card:____________________________________________

Signature of Card Holder:________________________________________

Student's Signature:_______________________________ Date:_________

MAIL COMPLETED FORM TO:
Binghamton University Dining Services
Meal Plan Office
Binghamton University
P.O. Box 6000
Binghamton, New York 13902-6000
(607) 777-6000  local number
(607) 777-6434 fax number
(888)-858-9167 toll free number

Please make checks payable to Sodexo.
Dining Services is not responsible for cash sent through the mail