| STUDENT, FACULTY/STAFF INFO: |
| CHOOSE ONE: |
STUDENT - LIVING ON CAMPUS
STUDENT - LIVING OFF CAMPUS
FACULTY/STAFF |
| *FIRST NAME: |
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| *LAST NAME: |
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| *PID (PID is your Person Identification number. This number is located on the front of MSU IDs below the cardholder name ): |
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| *E-MAIL: |
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| *PHONE: |
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| *AMOUNT TO DEPOSIT: |
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| Where did you hear about us: |
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| Other: |
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