Reservation Deposit Form
Students living on-campus
$300 reservation deposit
$200 room deposit
Students living at home*
$300 reservation deposit
The reservation deposit will serve as your contingency deposit for the duration of your enrollment at the University
of Lynchburg; therefore, this $300 may not be used for any other purpose. Deposits are non-refundable after May 1.
(Deposits from students admitted for Early Decision are non-refundable.)
Mailing address
Last name First Middle
Street City
State Zip
Phone Email
I affirm all the above information is correct. (Please contact the Office of Enrollment Services if any information changes.)
Payment options (Please return this form with payment)
Option 1
Payment by check
Please make the check payable
to University of Lynchburg and
mail it with this form to:
University of Lynchburg
Office of Enrollment Services
1501 Lakeside Drive
Lynchburg, VA 24501-3113
Option 3
Payment by credit card
Option 2
Payment online
Card #
Please charge to my:
q Visa
q Mastercard
q Discover
q American Express
Expiration date
Cardholder name
Cardholder address
Cardholder email
Cardholder signature
Cardholder phone
* University policy states that traditional age (under 25) students are expected to live on campus, unless living at home with parents.