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PAYMENT AGREEMENT AND

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PAYMENT AGREEMENT AND Powered By Docstoc
					PAYMENT AGREEMENT AND AUTOMATIC WITHDRAWAL AUTHORIZATION
Customer’s Name and Address (Buyer) (You) Creditor’s Name and Address (Seller) (We, Us)

The College Store
Phone Number: Email address: Customer’s Permanent Address (if different from above)

3503 Elgin Houston, TX 77004 Phone: (713)659-2665 Fax: (713)659-2625

Check Payment

(ATTACH PAYMENT HERE)

**** Check must be dated for date of Purchase ****
Driver’s License #: Driver’s License Expiration:

Credit Card (backup form of payment if check fails to clear) CREDIT CARD NUMBER EXPIRATION DATE: CID: ACCOUNT TYPE VISA

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MASTER CARD

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DISCOVER

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AMERICAN EXPRESS

ACCOUNT HOLDER NAME (As it appears on account)

1.

Promise to Pay You agree to pay us the amount shown as “Total of Payment” on or before the 24th of September 2009 in full. A description of the goods being purchased is: textbooks and other instructional materials in connection with course work at an institution of higher education.

2.

Authorization to Credit/Debit Account

(Check obtained on date of deferred purchase) You authorize and direct us to present this check to our bank on the 24th of September 2009. You represent and warrant that you are an authorized user or owner of said account and have legal authority to authorize said payment from the account provided above. If a withdrawal falls on a Saturday, Sunday or bank holiday, the payment will be withdrawn on the following business day. This authorization will remain in effect until the total amount has been paid in full. You agree to notify us in writing of any changes in the account information provided above prior to the next due date of any payment. If you terminate this authorization in writing prior to payment in full, you understand that you are still responsible for all outstanding payments and promise to pay in full the outstanding balance. You shall be in default of this agreement if any debit to the bank account provided above is returned for any reason. Upon an event of default, all remaining amounts may be accelerated so that the entire remaining unpaid balance of your debt must be paid at once. Upon default, you authorize us to charge the credit card you have provided for the entire amount outstanding. (Credit Card Number obtained on date of deferred purchase) You authorize and direct us to automatically credit or debit (as the case may be) the credit card, indicated above on the 24th of September 2009 if the initial form of payment above (via personal check) fails to be approved by your bank. You represent and warrant that you are an authorized user or owner of said account and have legal authority to authorize said payments from the account provided above. If a withdrawal falls on a Saturday, Sunday or bank holiday, the payment will be withdrawn on the following business day. This authorization will remain in effect until the total amount has been paid in full. You agree to notify us in writing of any changes in the account information provided above prior to the next due date of any payment. If you terminate this authorization in writing prior to payment in full, you understand that you are still responsible for all outstanding payments and promise to pay in full the outstanding balance. You shall be in default of this agreement if any debit to the card account provided above is returned for any reason. Upon an event of default, all remaining amounts may be accelerated so that the entire remaining unpaid balance of your debt must be paid at once. Upon default, you authorize us to charge the credit card you have provided for the entire amount outstanding. 3. Default In addition to the event of default described in Section 2 of this contract, you will be in default if you fail to make the scheduled payment or if you terminate your authorization for us to automatically debit your bank account prior to payment in full of all amounts owed to us. Upon an event of default, we may require that the entire balance of your debt to be paid at once, without prior notice or demand (except for any notices required by law). You understand that your account may be placed, without notice, with a law firm for collection purposes or in the case of a NSF return of check, filed for collection with the Harris County District Attorney. If we refer your account to collection to an attorney who is not our employee, you agree to pay reasonable attorney fees, court costs and any other amounts recoverable by law. Prepayment You can prepay any amount due under this contract at any time prior to the due date (9/24/09) without penalty. Miscellaneous This contract will be governed in accordance with the laws of the State of Texas. Time is of the essence of this agreement. No warranties express or implied, representations, promises or statements have been made by us unless indorsed herein in writing. No transfer, renewal, extension, or assignment of this contract, or loss, injury or destruction of the goods purchased in connection with this transaction shall release you form your obligation hereunder. NOTICE TO BUYER 1. 2. 3. Do not sign this contract before you read it or if it contains any blank spaces. You are entitled to an exact copy of the contract you sign. Keep it to protect your legal rights. You have the right to pay off in advance the full amount due.
RECEIPT OF A COPY OF THIS CONTRACT IS HEREBY ACKNOWLEDGED BY THE BUYER.

4. 5.

BUYER:

Date: _______________________

________________________________________________________ Signature of account holder or authorized user

______________________________________ Social Security Number

________________________________________________ Printed Name

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