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Personal Information
Parent or Student Email:
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Student First Name:
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Student Last Name:
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Daytime Phone (xxx-xxx-xxxx):
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-
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College:
Select a college
Columbia College
Indiana State
Lindenwood University
Warehouse
Roosevelt
SAIC
Robert Morris
John Marshall
DePaul
Harold Washington
University of Illinois – Chicago
University of Chicago
Flashpoint Academy
Joffrey Ballet
Tiffin University
Calvin College
Fresno State University
Neosho County Community College
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Residence Hall (if known):
Room (if known):
Billing Address
Payer First Name:
*
Payer Last Name:
*
Address Line 1:
*
Address Line 2:
City:
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State:
Select a state
Armed Forces Americas (except Canada)
Armed Forces Europe (covers all USARAEUR)
Alaska
Alabama
Armed Forces Pacific
Army/Air Force Post Office
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Fleet Post Office
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
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Postal Code:
*
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Credit/Debit Card Information
Your credit/debit card will be charged an amount of $95.
(Plus applicable sales tax).
Credit/Debit Card Type:
Visa
MasterCard
Discover
Amex
Credit/Debit Card Number:
*
Enter number without dashes or spaces.
Security Code
:
*
Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
/
2024
2025
2026
2027
2028
2029
2030
Please be advised that once you click [Create Account] below, an email will be generated to the email address above with instructions on how to activate the safe in the students room. Thank you from CSI Safes, LLC., a safe alternative to keeping your possessions safe and secure.