Orientation Housing Payment And Confirmation Reservation Form

Rate: $20 per person per night.

Payment:  Can be made via this form with Credit Card or eCheck, or through the Cashiers using Cash or Check.

If you are paying in cash or check please visit the Cashiering Office prior to check in.  The Cashiering Office is open Monday through Thursday from 9am to 4pm and Friday from 9am to 2pm.  You MUST pay before you check-in.  We do not accept any form of payment including cash or checks at check-in.   

If you have any questions, please contact Debbie Henderson dhenderson8@ucmerced.edu or by phone 209-228-3137.

(Items with * are required.)

Contact Information

Student ID:
Student First Name: *

Student Last Name: *

Student Email: *

Primary Day Telephone Number/Cell *

Primary Evening Telephone Number/Cell

Name & Relationship to UC Merced Student for each attendee: *

Emergency Contact Name *

Emergency Phone Number *


Reservation Details

Total number of occupants for this reservation: (include student): *

Disability accommodation required *

Special Needs Notes
Arrival Date: *

Check-In Time (Approx.): *

Departure Date: *

Check-out Time (Approx) *


Payment Information

Please enter amount:
( Attendees X $20 X Nights ) *

Will you be paying on-line? *


 
 

(Items with * are required.)

Input the digits into the box below.

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