Payment for UMKC Conservatory of Music and Dance

Locker Rental

I, __Pyero Talone_____________________________, agree to have the following locker

rental charges placed on my student account:

Academic Year: __2020-21

Locker Number: __________________
Rental Fee: ______$10.00__________
Date Locker Must be emptied: June 1, 2020

Failure to pay the UMKC Cashiers Office as agreed will result in a cashiers hold on my
student account, prohibiting, registration, release of grades, etc. until the University of
Missouri – Kansas City has received full reimbursement.

Student ID #: _16290818_________________________________________
Name (printed): _Pyero Talone_____________________________________
Signature: __________________________________________________
Date Authorized: _08/06/2020________________________________________

For Cashiers Office:

Funds Distribution as Follows:
KDH63 – 495000

Upd October 28, 2015