PRIME Business Dining

Declining Balance Plan

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Student or Staff: *

HVCC ID: *

Add Additional Dollars *

Total Amount

$0.00

Authorization *

I authorize Mazzone Hospitality to charge my credit card for this declining balance deposit.

I authorize Mazzone Hospitality to charge my credit card for this declining balance deposit. Charge will appear on credit card statement as "Glen Sanders Mansion". I understand declining balance funds are non-refundable. All unused dollars at the end of the Summer Semester are forfeited.

I Understand *

I understand that this is my agreement with Mazzone Hospitality for enrollment in the Declining Balance Plan.

I understand that this is my agreement with Mazzone Hospitality for enrollment in the Declining Balance Plan and that I may make additional deposits at any time in the future.

PRIME Business Dining

Declining Balance Plan

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