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PAYMENT AGREEMENT AND PROMISSORY NOTE

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PAYMENT AGREEMENT AND PROMISSORY NOTE Powered By Docstoc
					                                                                                                             Revised 6/2011




                PAYMENT AGREEMENT AND PROMISSORY NOTE

For charges incurred while enrolled at the University of La Verne, I promise to pay the University of La Verne, the
principal sum of all tuition and fees representing the balance of my account. I further acknowledge that I will not be
allowed to register for a subsequent semester/term if I have not paid in full the previous semester/term or made the
appropriate financial arrangements. Further, I understand that should I withdraw from the University the balance will
become due immediately.

1.   I will be assessed and agree to pay the University of La Verne a fee for the return by a depository institution of
     any dishonored check, negotiable order of withdrawal or share draft issued in connection with this account.

2.   I agree this note and all my other obligations, direct or contingent, or those of any endorser hereof, to the
     University of La Verne, upon election of the University of La Verne shall become due and payable immediately,
     without demand or notice, upon default in payment or performance of this note or any obligation to the
     University of La Verne.

3.   In the event I fail to make payment in full by the date of the last monthly installment, I agree to pay any interest on
     the unpaid balance at the rate of 10% per annum (computed on the basis of a 360-day year).

4.   I promise to pay all attorney’s fees and other reasonable collection costs and charges necessary for the collection
     of any amount not paid when due. However, if the University of La Verne uses a collection agency, which is
     subject to the Fair Debt Collection Practices Act, I will pay those collection costs which do not exceed 30% of the
     unpaid principal and interest.

5.   I further understand and agree that if Financial Aid is utilized in computing my registration down payment, I agree
     to allow the University of La Verne to apply these funds to my account.

6.   I agree that the terms and conditions, including rights and remedies, under this agreement will also apply to any
     party to whom the University of La Verne may assign this agreement.


Student’s Name (Please Print)                                                   Student ID#


Student Signature                                    Date                        Birth date


Permanent Address


City                                               State                         Zip


Telephone #                  Social Security #                  Drivers License #                Drivers License State

Note: If you are under the age of 18, we require that your parent/guardian complete and sign the Payment Agreement
     and Promissory Note.


Parent/Guardian Name (Please Print)                  Parent/Guardian Signature                        Date


                    Student Accounts • 1950 3rd Street • La Verne, California 91750
                                    (909) 593-3511 extension 4060

				
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