Payment Agreement by mtb29869


Payment Agreement document sample

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									                                                                                                              Student Receivable
                                                                                                               Fax: 956-364-5133
  1902 N. Loop 499          I Harlingen, TX 78550                                                                   800.852.8784

                                                     PAYMENT AGREEMENT

                          ID#:                              A/R Type:                         Term:

     I,                                                 ,       agree to pay my balance with TSTC of
    by making payments as shown below, until my account is paid in full.

                                                                 due             today
                                                                due on
                                                                due on
                                                                due on
                                                                due on

    Payments made with cashier's check or money order may be mailed to:
        Student Receivable Office, TSTC Harlingen, 1902 N Loop 499, Harlingen, TX 78550
    Payments made with cash, credit card, cashier's check, or money order may be made at the Cashier's Office in the Student
    Services Building.

             A hold may be put on my account until my balance is paid in full.
             If payment is not made by the due date, the student risks being dropped or barred from class. If these payments
             are not completed before the start of the new semester, classes for the new semester may be dropped.

             Withdrawing or dropping a course does not void the obligation for repayment of this debt.
             I authorize TSTC to transfer any future credit balance on my account to clear this balance.

                                                                                           Signature                    Date

                                                    Current phone number:
                                                    Current mailing address:

                                                             E-mail address:

    Approved by:                                              (name)        on                  (date)

          Copy of agreement given to student.
          DBT code is present on student's account, and details of arrangement in PERC accounts.
          Agreement scanned on                     (date) and then to Payment Arrangement binder.

TSTC-2-FA-057 (05/1/10)

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