Leasing_Form

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Campus Computer Sales - Order Form 1) List your desired items, then subtotal: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ______________________________________________________ Subtotal = $ ________________ 2) Leasing Options (choose a plan): 24 MONTH LEASE-TO-OWN I authorize Queen’s University to directly debit $ ____________ (subtotal multiplied by .03989) plus 14% taxes totaling $ ___________ from my chequing account at the end of each month for the term selected above. 36 MONTH LEASE-TO-OWN I authorize Queen’s University to directly debit $ ____________ (subtotal multiplied by .02738) plus 14% taxes totaling $ ___________ from my chequing account at the end of each month for the term selected above. I will pay the 10% downpayment of $ ___________ (subtotal multiplied by .10) plus 14% taxes plus the $50.00 administration fee (do not apply taxes to admin fee) for a grand total of $ ___________ by cheque on the credit card below. I have attached a void cheque confirming my account details (must be a regular Canadian chequing account). I am responsible for providing theft and damage insurance on the leased equipment. I understand that I am responsible for all components included in the system. I am authorized to make payment on the credit card below and Queen’s University can use the credit card number below should I default on my automatic payment. I understand that a $15 NSF charge will occur should I default on a payment. (Credit card information is required in order to process lease.) 3) Payment Options (choose a method): Full Payment by Cheque Full Payment by Credit Card Credit Card Information for Lease MasterCard/Visa ___________________________________________________________ Expiry ____________________ Signature ___________________________________________________________________________________________ ____ 4) Personal Information: Name ______________________________________________________ Student Number ___________________________ Home mailing address __________________________________________________________________________________ ____________________________________________________________________________________________________ Home telephone __________________________________ Home fax ___________________________________________ Home e-mail __________________________________________________________________________________________ FREE DELIVERY (WITHIN CANADA) TO THIS ADDRESS? YES NO (available to currently enrolled students during July & August) MAIL: Campus Computer Sales & Service - Queen’s University, Dupuis Hall - Kingston, Ontario FAX: K7L 3N6 1.613.533.6798 PHONE: 1.866.419.0636 WEB: http://ccstore.queensu.ca

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