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Enrollment Application Form

Contact Information
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Merchant Mailing Address
Discount Information
 Students     Faculty/Staff   
By checking this box, you warrant that you have read and accepted the i-card Perks Program Terms and Conditions. You agree to provide all the necessary information to have your product or service listed on the i-card Perks Program Web site. Failure to provide all such information could result in a delay in processing your form. You agree to provide written notification to the i-card Programs office about discontinuation, manufacturer recalls or any other information about your product or service that may not meet the mission and values of the University of Illinois.