Monthly Installment Plan Agreement

Fall 2017 (201801)

CONCORDUNIVERSITY

MONTHLY INSTALLMENT PLAN AGREEMENT

____ NAME: (LAST) (FIRST) (M.I.) STUDENT IDENTIFICATION #

______ADDRESS: (STREET) (CITY) (STATE) (ZIP CODE) HOME PHONE#

I request permission to divide my monetary obligation to ConcordUniversityinto FOUR installments. By making this request, I agree to all of the following terms and conditions:

TERMS & CONDITIONS

1. The initial installment payment must be equal to or greater than 25% of the outstanding balance after application of all financial aid.
2. A one time non-refundable service fee of $50.00 will be added to the initial installment payment.
3. The monthly installment plan requires Fall 2017 semester payments to begin in July 2017 and end in October 2017. Should any monthly installment payment not be received by the Business Office by the due date, this contract will be accelerated and payment in full will be due immediately.In any instance where a monthly payment is delinquent, a late fee of $25.00 will also be assessed on the student account.
4. The amount of tuition, fees, room and board assessed, during the semester of this contract, is the amount you will be obligated to pay regardless of courses droppedand/or changes infinancial aid awarded.
5. Your final payment will be adjusted to reflect any additional assessments to the student account.
6. If the required payments are not met, a monetary hold will be placed on the student account.
7. Your copy of this contract constitutes notification for each monthly installment.Regular billing statementswill not be generated.
8. I understand that failure to meet any and all of my monetary obligations to Concord University will result in the University pursuingcollection with interest and/or applicable collection agency fees and/or legal fees.

This agreement is completed with accuracy as of this date. I acknowledge that I have read this agreement and understand the terms and conditions as provided. I fully understand my financial obligations to ConcordUniversity.

______

Student Signature and/or Co-Signor Signature (Student under the age of eighteen) Date

______

Authorized Concord University Accountant Date

Tuition & Fees: $______First Payment:

(Includes Service Fee) $______DueJuly 20, 2017

Room: $______

Second Payment: $______Due August18, 2017

Board: $______

Third Payment: $______Due September 20, 2017

Subtotal: $______

Less Financial Aid: $______Fourth Payment: $ ______Due October 20, 2017

$______

Adjustments: $ ______

$______

$ ______

$______

$ ______

$______

Final Payment:$ ______DueOctober 20, 2017

Net Balance Due: $______

Monthly Payments: $______

(Net Balance Due divided by 4)

Service Fee: $ 50.00

WHITE COPY: BUSINESS OFFICE YELLOW COPY: FILE COPY PINK COPY: FOURTH FINAL PAYMENT GOLD COPY: STUDENT