Visiting Group Reservation Form

Group Name *

Group Contact Name

First

Last

Group Contact Phone Number *

Group Contact Email Address *

U-M Department Affiliate/Sponsor

U-M Department Affiliate/Sponsor Email Address

Size of Group *

Or estimate

Age of Group *

10 and under

11 - 14

15 and up

OtherOther

Desired Visit Location *

Bursley Dining Hall - North Campus

East Quad Dining Hall

Mosher-Jordan Dining Hall

South Quad Dining Hall

Fireside Café - North Campus

Maizie’s Kitchen and Market

Other Michigan Dining HallOther Michigan Dining Hall

Other Michigan Dining RetailOther Michigan Dining Retail

If you are reserving at Fireside Café or Maizie's Kitchen and Market, please pick up your vouchers from a manager before you proceed through the line for payment.
Please note "Other" Dining Halls or Retail Spaces may not be accommodated due to the volume of people served in our spaces.

Date of Visit *

Desired Meal *

Breakfast

Lunch

Dinner

Desired Time of Visit - Breakfast *

Desired Time of Visit - Lunch *

11:30 am

12:45 pm

1:00 pm

1:30 pm

OtherOther

Please note "Other" times may not be accommodated due to the volume of people served in our dining halls.

Desired Time of Visit - Dinner *

Dining Hall Form of Payment *

U-M Department Shortcode

U-M Blue Bucks Department Card

Invoice (Paid with Check or Credit Card)

For groups paying by check or credit card, the invoice will be sent after your visit.
Payment via check and credit card are subject to Michigan state sales tax

Do you have a Blue Bucks Department Card? *

Yes

No

U-M Department Shortcode *

Authorized Signer *

UMID of Blue Bucks Department Card *

Invoice Billing Details

Name

First

Last

Address

City

State

Zip

Billing Email *

Phone Number *

Are you a non-profit organization that can provide tax-exempt documentation?

Yes

No

We must receive the proper tax-exemption form prior to the date of the visit, if this is not received the invoice will be charged the applicable sales tax. When we reach out to confirm your event we will ask for your tax-exemption documentation

To best accommodate your visit, we would like to crate a department inclining Blue Bucks Mcard for you.

The card will be linked to a shortcode and be charged based on usage at the end of every month. A report detailing the charges will also be emailed to a specified address at the requested time-frame. The card takes 3-5 business days to process and you do not need bring the physical card for your visit. If you have any further questions please email bluebucks@umich.edu.

Requestor Name

First

Last

Requestor Email Address *

Supervisor/Department head

First

Last

Supervisor/Department head email address *

Department Name/Card Name *

If you would like a physical card, this is the name that will appear on the front of the card - please be specific

Shortcode *

Would you like a report emailed detailing the spending?

Yes

No

How often should a report be sent?

Daily

Weekly (sent Monday for previous week's spending)

Monthly (sent 1st of month for previous month's spending)

What email address(es) should the report be emailed to? *

Add email addresses separated by a comma.

Would you like a physical copy of this card?

Yes (The card will be sent via campus mail)

No

Campus Mail Information

Name & Department

Street Address

Campus Zip

Room

Building

Comments/Additional Information

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