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Payment Option Form The three payment options for submitting the $200 housing deposit are: cash check (made payable to Emmanuel College) credit/debit card Please submit your payment to the Residence Life and Housing Office in St. Ann Hall. If you would like to pay with a credit or debit card, please submit this completed form to the Residence Life and Housing Office. In order to cancel your housing and receive a 50% refund of your housing deposit, you must submit the Housing Cancellation Request on the Portal prior to Monday, May 2, 2011. If this form is submitted after May 2, 2011, but before August 31, 2011, you are eligible to cancel your housing lease, but your $200 Housing Deposit will be forfeited. I authorize Emmanuel College to charge this card $200 as a housing deposit.

Student’s name: ________________________________________________________________ Student’s Emmanuel College ID number: ____________________________________________


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