Request for Casual Accommodation

To submit this form: complete and save to your desktop and email as an attachment to

Personal Details:

Title:First Name: Last Name:

StudentStudent Number:

Non StudentPurpose of Stay:

Age (optional): (this information assists us with room allocations).

Contact Details:

Postal Address: Suburb:

Postcode: State: Country:

Telephone: Mobile: Email:

Accommodation Required [subject to availability]:

Arrival Date: Time: Departure Date: Time:

Room Type – 1stPreference: Room Type – 2nd Preference:

Additional Details:

Laundry:

Most laundries at the Halls operate on a prepaid system, which requires a proximity key (called a "Fob") and a PIN to operate the machines. The cost to wash or dry is $3 per cycle. If you will require laundry access during your stay, please indicate herein, and specify the credit you would like to establish on your pre-paid account. Please note laundry credits are non-refundable.

Yes, I require laundry access – please include $ laundry credit in my booking payment.

Payment Details:

To finalise your booking, full upfront payment is required for stays of 1 week or less, and weekly in advance for longer stays. Bookings will not be confirmed until payment is received.

Should your circumstances change and you wish to cancel this booking, your payment will be refunded, less a cancellation fee of $45, provided you let us know at least 48hrs prior to arrival. Please advise if you are unable to utilise one of the payment methods below.

Cheque/Money Order: payable to JCU Halls of Residence

Bank Deposit: BSB: 064817 / Account Number: 00050027 (use your name as payment reference)

Credit Card:MasterCardVisa

**We do not accept Diners or Amex. Please note that an additional 0.5% processing fee will be charged for all credit card transactions.

Credit Card Details

Card Holders Name:

Card Number:

Expiry Date:/

All information provided herein will be used exclusively for the purpose specified in this form and treated with complete confidentiality. This information will not be stored electronically; original hardcopies are kept in a secure location and will be destroyed after an appropriate period of time.

Invoice [JCU internal use only]:

Please send invoice to:

Contact Name: Position:

Email: Extension:

Department Address:

OFFICE USE ONLY
Booking: / Request / Form Received: / Booking Confirmed:
Rate: / $ / Per nightweek / Hall: GRHRIHUHWC / Room:
Dates: / Confirmed / Tentative / FOB Created:
Payments / Upfront : / Paid: $ / Date: / Receipt:
Weekly:
Notes:

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