[pic]
Liberty University Dining
Fall 2012 Commuter Meal Plans PLANS TOTAL COST (includes tax) *Check One Please

___Block 30 30 swipes $196.24
___Block 60 60 swipes $376.87
___Block 90 90 swipes $512.90
___Flex 20 20 swipes, 200 points $334.50 ___Flex 30 30 swipes, 300 points $501.75

• Please return this form to the dining office located in the rear of the dining hall or call us at 434-582-2262, fax 434-582-4662, or email it libertydining@liberty.edu • Plans can be purchased at any time during the semester and are valid until May 11, 2013. • Meal Points can be purchased at any time during the semester and are valid until May 11, 2013. Additional points are subject to the 11.5% sales tax. Receive 5% Bonus on any meal points purchase over $25. • Purchase by September 17, 2012 and receive 10 Free Meal Points

Last Name_____________________ First Name______________________ MI______

LU ID #_______________ Phone__________________ Email____________________

Meal Plan Cost ____________________

Additional Point Amt. ____________________
(+) 11.5% Sales Tax on Points Only____________

Total Cost _____________________________
____________________________________________________________________________________

Method of Payment: (Check One)

Cash ____ Visa ____ American Express ____ Master Card ____ Discover ____
Commuter plans cannot be charged to your student account; however, if you have a credit balance on your account, you may take this form to the Student Service Center for approval. The cost will then be deducted from your credit balance.

** Student Service Center Approval (if necessary) ______________________ Date