Lofts, LLC, Online Order Form

Fill-in the form on this page. When you click "SUBMIT" your information will be sent to Lofts, LLC personnel. You will receive a confirmation email when your payment is finalized. [At this time this is not a completely secure method of payment. Your credit card though will be processed by hand by Lofts, LLC and not online.]

* = Required fields!

Student Name*:

If your dorm assignment has not been made, please type "will advise" in the space provided for both 'Dorm Name' and 'Room Number'.

Dorm Name*:

Room Number*:

Home Phone*:

Student's Cell Phone:

Home Address*:

Home City*:

Home State*:

Home Zip*:

Student's Email:

Lower Loft Bed?:

Do I Need Early Installation?:

If you chose "Yes" above, please state the early date of arrival:

By checking the box below the parent or guardian of the student, understands and agrees with the Lofts, LLC, Terms & Conditions

Yes, the parent or guardian, understands and agrees*:

By checking the box below the student, understands and agrees with the Lofts, LLC, Terms & Conditions

Yes, I, the student, understand and agree*:

Rental Options*:

Method of Payment: (choose one)

Please type the full name on the card you will be paying with:

Credit card number:

Expiration date:

Month: Year:

If your credit card billing address is different than the "Home Address" stated above, please enter the billing address information below:

Billing Address:

Billing City:

Billing State:

Billing Zip:

After you click the "Submit" button, you will be directed to choose and complete your purchase for one of the Lofts, LLC, rental options.