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
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